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Alcohol Withdrawal

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1. Barbituates in the Management of Alcohol Withdrawal Syndrome

Barbituates in the Management of Alcohol Withdrawal Syndrome Barbituates in the Management of Alcohol Withdrawal Syndrome | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search Vignette You’re slogging through another morning shift in the Behavioral Health pod. Your overnight colleague signed you out a rock garden, including a patient (...) with alcohol use disorder who is”awaiting sobriety.” After seeing a couple of new patients, you head up to the cafeteria for a leisurely breakfast. After you finish your hash browns and sausage and grab a cup of Jason Wagner coffee from the 8th floor, you return to the BHP. One of your sign-out patients is now tremulous, diaphoretic, and agitated, and you ask the nurse to check a set of vitals. She finds the patient to be tachycardic and hypertensive, and you diagnose the patient with alcohol withdrawal

2020 Washington University Emergency Medicine Journal Club

2. Alcohol withdrawal

Alcohol withdrawal Alcohol withdrawal - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Search Select language Alcohol withdrawal Last reviewed: December 2019 Last updated: March 2019 Summary Alcohol withdrawal is caused by the abrupt cessation of alcohol consumption in patients with alcohol dependence or chronic alcoholism. The clinical presentation consists of a spectrum of signs and symptoms, including autonomic (...) hyperactivity, tremulousness, restlessness, through to seizures and potentially life-threatening delirium tremens. Alcohol withdrawal syndrome is a clinical diagnosis. Symptom-triggered therapy with benzodiazepines remains the cornerstone of management. Definition Alcohol withdrawal syndrome (AWS), commonly referred to as 'the shakes', occurs in patients with alcohol dependence when their daily alcohol consumption is decreased or stopped. The decrease in blood ethanol below the level at which the patient

2019 BMJ Best Practice

5. Alcohol withdrawal

Alcohol withdrawal Alcohol withdrawal - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Alcohol withdrawal Last reviewed: February 2019 Last updated: March 2019 Summary Alcohol withdrawal is caused by the abrupt cessation of alcohol consumption in patients with alcohol dependence or chronic alcoholism. The clinical presentation consists of a spectrum of signs and symptoms, including autonomic hyperactivity (...) , tremulousness, restlessness, through to seizures and potentially life-threatening delirium tremens. Alcohol withdrawal syndrome is a clinical diagnosis. Symptom-triggered therapy with benzodiazepines remains the cornerstone of management. Definition Alcohol withdrawal syndrome (AWS), commonly referred to as 'the shakes', occurs in patients with alcohol dependence when their daily alcohol consumption is decreased or stopped. The decrease in blood ethanol below the level at which the patient is habituated

2017 BMJ Best Practice

6. Baclofen for alcohol withdrawal. Full Text available with Trip Pro

Baclofen for alcohol withdrawal. Baclofen shows potential for rapidly reducing symptoms of severe alcohol withdrawal syndrome (AWS) in people with alcoholism. Treatment with baclofen is easy to manage and rarely produces euphoria or other pleasant effects, or craving for the drug. This is an updated version of the original Cochrane Review published in 2015, Issue 4.To assess the efficacy and safety of baclofen for people with AWS.We updated our searches of the following databases to March 2017 (...) with AWS. We excluded uncontrolled, non-randomised, or quasi-randomised trials. We included both parallel group and cross-over studies.We used standard methodological procedures expected by Cochrane.We included three RCTs with 141 randomised participants. We did not perform meta-analyses due to the different control interventions. For the comparison of baclofen and placebo (1 study, 31 participants), there was no significant difference in Clinical Institute Withdrawal Assessment of Alcohol Scale

2017 Cochrane

7. Pathways for management of alcohol withdrawal in critical care units

Pathways for management of alcohol withdrawal in critical care units Pathways for management of alcohol withdrawal in critical care units Pathways for management of alcohol withdrawal in critical care units Mitchell MD, Jablonski, J, Mull, N. Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Mitchell MD, Jablonski, J, Mull, N.. Pathways (...) for management of alcohol withdrawal in critical care units. Philadelphia: Center for Evidence-based Practice (CEP). 2017 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Alcoholism; Critical Care; Humans; Intensive Care Units; Substance Withdrawal Syndrome Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence Center for Evidence-based Practice, University of Pennsylvania Health System

2017 Health Technology Assessment (HTA) Database.

8. Medications for critical care patients with alcohol withdrawal

Medications for critical care patients with alcohol withdrawal Medications for critical care patients with alcohol withdrawal Medications for critical care patients with alcohol withdrawal Mitchell MD, Martin ND, Mull, N. Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Mitchell MD, Martin ND, Mull, N.. Medications for critical care (...) patients with alcohol withdrawal. Philadelphia: Center for Evidence-based Practice (CEP). 2017 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Alcoholism; Critical Care; Humans; Substance Withdrawal Syndrome Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market St. Suite 50, Philadelphia PA

2017 Health Technology Assessment (HTA) Database.

9. Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials (Abstract)

Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials Benzodiazepines are the standard medication class for treating alcohol withdrawal. Guidelines recommend dosing based on objectively measured symptoms (symptom-triggered therapy) rather than fixed dose regimens. However, the superiority of symptom-triggered therapy has been questioned, and concerns have been raised about its inappropriate use and safety. We aimed (...) to assess whether symptom-triggered therapy is superior to fixed dose schedules in terms of mortality, delirium, seizures, total benzodiazepine dose, and duration of therapy.A systematic literature search using Medline, Embase, and the Cochrane Registry through February 2018 was conducted for randomized controlled trials of patients with alcohol withdrawal syndrome comparing fixed dose benzodiazepine schedules to symptom-triggered therapy. Risk of bias was assessed using the Cochrane Risk of Bias Tool

2019 EvidenceUpdates

10. Baclofen for alcohol withdrawal. (Abstract)

Baclofen for alcohol withdrawal. The treatment baclofen shows potential for rapidly reducing symptoms of severe alcohol withdrawal syndrome (AWS) in people with alcoholism. Treatment with baclofen is easy to manage and rarely produces euphoria or other pleasant effects, or craving for the drug. This is an updated version of the original Cochrane review published in Issue 2, 2013.To assess the efficacy and safety of baclofen for people with AWS.We searched the Cochrane Drugs and Alcohol Group (...) by an independent party. We contacted study authors for additional information where needed. We collected adverse effects information from the trials.Two RCTs with a total of 81 participants were eligible according to the inclusion criteria. One study suggested that both baclofen and diazepam significantly decreased the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) score, without any significant difference between the two interventions. The other study showed no significant

2015 Cochrane

11. Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. (Abstract)

Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3-5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few (...) physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3

2018 Internal and emergency medicine

12. Alcohol Withdrawal Management for Acute Care Inpatients

Alcohol Withdrawal Management for Acute Care Inpatients Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along (...) . It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions. TITLE: Alcohol Withdrawal Management for Acute Care Inpatients

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

13. Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. Full Text available with Trip Pro

Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. Although severe alcohol withdrawal syndrome (SAWS) is associated with substantial morbidity and mortality, most at-risk patients will not develop this syndrome. Predicting its occurrence is important because the mortality rate is high when untreated.To assess the accuracy and predictive value of symptoms and signs for identifying hospitalized patients at risk of SAWS (...) with exclusion of SAWS. Six high-quality studies evaluated combinations of clinical findings and were useful for identifying patients in acute care facilities at high risk of developing SAWS. Of these combinations, the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) was most useful, with an LR of 174 (95% CI, 43-696; specificity, 0.93) when patients had 4 or more individual findings and an LR of 0.07 (95% CI, 0.02-0.26; sensitivity, 0.99) when there were 3 or fewer findings.Assessment tools that use

2018 JAMA

14. Alcohol Abuse or Alcohol Withdrawal: Risk of Latent Scurvy

Alcohol Abuse or Alcohol Withdrawal: Risk of Latent Scurvy Alcohol Abuse or Alcohol Withdrawal: Risk of Latent Scurvy - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Alcohol Abuse or Alcohol Withdrawal (...) Study Description Go to Brief Summary: Scurvy, or latent scurvy, may be underestimated in developed countries, but continue to be described, often as case report. Little is known about the prevalence of vitamin C deficiency in a specific population as withdrawal alcoholics and about his possible consequences, latent scurvy. In an observational study, the investigators will evaluate prospectively the prevalence of vitamin C deficiency in alcoholic withdrawal patients, its correlation with latent

2018 Clinical Trials

15. Glutamate concentration in the anterior cingulate cortex in alcohol dependence: association with alcohol withdrawal and exploration of contribution from glutamatergic candidate genes Full Text available with Trip Pro

Glutamate concentration in the anterior cingulate cortex in alcohol dependence: association with alcohol withdrawal and exploration of contribution from glutamatergic candidate genes 29985185 2019 01 02 2019 01 02 1473-5873 28 5 2018 10 Psychiatric genetics Psychiatr. Genet. Glutamate concentration in the anterior cingulate cortex in alcohol dependence: association with alcohol withdrawal and exploration of contribution from glutamatergic candidate genes. 94-95 10.1097/YPG.0000000000000202 (...) Psychopharmacology. Rietschel Marcella M Departments of Genetic Epidemiology in Psychiatry. Ende Gabriele G Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. eng Journal Article Research Support, Non-U.S. Gov't England Psychiatr Genet 9106748 0955-8829 0 GATA4 Transcription Factor 0 GATA4 protein, human 3KX376GY7L Glutamic Acid MU72812GK0 Creatine IM Adult Aged Alcoholism genetics metabolism Case-Control Studies Creatine metabolism Female GATA4

2018 Psychiatric genetics

16. Baclofen for alcohol withdrawal. (Abstract)

Baclofen for alcohol withdrawal. The treatment baclofen can rapidly reduce symptoms of severe alcohol withdrawal syndrome (AWS) in alcoholic patients, with a significant reduction in the cost. Baclofen is easy to manage, and rare euphoria, craving and other pleasant effects are reported by patients treated with baclofen.To assess the efficacy and safety of baclofen for patients with AWS.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (October (...) the trials.We identified a total of 113 references from all electronic databases searched excluding duplicates. After screening of titles and abstracts, full papers of 10 studies were obtained and assessed for eligibility. Finally, two RCTs with 81 participants were eligible according to the inclusion criteria. Regarding the efficacy, one study suggested that both baclofen and diazepam significantly decreased the Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) score, without any

2013 Cochrane

17. Magnesium for alcohol withdrawal. (Abstract)

Magnesium for alcohol withdrawal. Patients have been given magnesium to treat or prevent alcohol withdrawal syndrome (AWS). Evidence to support this practice is limited, and is often based on the controversial link between hypomagnesaemia and AWS.To assess the effects of magnesium for the prevention or treatment of AWS in hospitalised adults.We searched the Cochrane Drugs and Alcohol Group Register of Controlled Trials (August 2012), PubMed (from 1966 to August 2012 ), EMBASE (from 1988 (...) for Alcohol (CIWA) score. A single outcome (handgrip strength) in three trials (113 people), was amenable to meta-analysis. There was no significant increase in handgrip strength in the magnesium group (SMD 0.04; 95% CI -0.22 to 0.30). No clinically important changes in adverse events were reported.There is insufficient evidence to determine whether magnesium is beneficial or harmful for the treatment or prevention of alcohol withdrawal syndrome.

2013 Cochrane

18. Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. (Abstract)

Low serum magnesium and 1-year mortality in alcohol withdrawal syndrome. In 2014, the WHO reported that 6% of all deaths were attributable to excess alcohol consumption. The aim of the present study was to examine the relationship between serum magnesium concentrations and mortality in patients with alcohol withdrawal syndrome (AWS).A retrospective review of 700 patients with documented evidence of previous AWS indicating a requirement for benzodiazepine prophylaxis or evidence of alcohol (...) withdrawal syndrome between November 2014 and March 2015.Of 380 patients included in the sample analysis, 64 (17%) were dead at 1 year following the time of treatment for AWS. The majority of patients had been prescribed thiamine (77%) and a proton pump inhibitor (66%). In contrast, the majority of patients had low circulating magnesium concentrations (<0.75 mmol/L) (64%) and had not been prescribed magnesium (90%). The median age of death at one year was 55 years (P = 0.002). On univariate analysis, age

2019 European journal of clinical investigation

19. High-Dose Gabapentin for the Treatment of Severe Alcohol Withdrawal Syndrome: A Retrospective Cohort Analysis. (Abstract)

High-Dose Gabapentin for the Treatment of Severe Alcohol Withdrawal Syndrome: A Retrospective Cohort Analysis. Gabapentin has been proved to be beneficial in promoting abstinence, decreasing alcohol cravings, and improving mood and sleep quality when given at higher doses; however, data are limited regarding the efficacy and safety of using high-dose gabapentin as part of the treatment of alcohol withdrawal syndrome (AWS). The aim of this study was to evaluate the impact of high-dose gabapentin (...) on benzodiazepine requirements, alcohol withdrawal symptoms, and hospital length of stay in patients hospitalized with AWS.Retrospective cohort study.Large academic medical center.All adults presenting to the emergency department between January 2015 and April 2018 with a diagnosis of severe AWS (Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised [CIWA-Ar] score ≥ 15) and prescribed the institution's alcohol withdrawal agitated delirium protocol were eligible for inclusion in the study

2019 Pharmacotherapy

20. Increased IL-6 expression in astrocytes is associated with emotionality, alterations in central amygdala GABAergic transmission, and excitability during alcohol withdrawal. (Abstract)

Increased IL-6 expression in astrocytes is associated with emotionality, alterations in central amygdala GABAergic transmission, and excitability during alcohol withdrawal. Accumulating evidence from preclinical and clinical studies has implicated a role for the cytokine IL-6 in a variety of CNS diseases including anxiety-like and depressive-like behaviors, as well as alcohol use disorder. Here we use homozygous and heterozygous transgenic mice expressing elevated levels of IL-6 in the CNS due

2019 Brain, behavior, and immunity

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