Acute alcohol withdrawal

Acute pancreatitis is a frequent cause of hospitalization, with the most common triggers being alcohol consumption and gallstones. Although the incidence of drug-induced pancreatitis remains low, it is steadily increasing due to the advent of newly discovered broad-spectrum antibiotics targeting multi-drug resistant organisms. Tigecycline, a broad-spectrum intravenous antibiotic derived from the tetracycline class, was approved by the FDA in 2005 for the treatment of complicated skin and skin structure infections, complicated intra-abdominal infections, and community-acquired pneumonia...

PURPOSE/OBJECTIVE(S): Non-cancer patients prescribed chronic courses of opioids are at high risk of psychiatric or drug overdose particularly during the post-tapering period, but data are limited on this effect in cancer survivors. This study quantified emergency room visits or hospital admissions for psychiatric or drug/alcohol overdose/withdrawal (henceforth "events") in cancer survivors prescribed opioids related to their cancer diagnoses. MATERIALS/METHODS: We identified 15,002 cancer survivors in SEER-Medicare diagnosed between 2010 and 2017 with bladder, breast, colon/rectal, kidney, lung, head/neck, or prostate cancer who were prescribed at least 6 months of stable opioids following their cancer diagnosis...

Prepulse inhibition (PPI) is a measure of sensorimotor filtering thought to shield the processing of initial weaker auditory stimuli from interruption by a later startle response. Previous studies have shown smoking withdrawal to have a negative impact on sensorimotor filtering, particularly in individuals with psychopathology. Because tobacco use may alleviate sensory and sensorimotor filtering deficits, we examined whether smoking withdrawal-induced changes in PPI were associated with maintenance of smoking abstinence in trauma-exposed individuals with and without PTSD who were attempting to quit smoking...

Cannabis use disorder (CUD) presents differently in men and women, particularly in symptoms of cannabis withdrawal. Novel pharmacotherapeutic interventions for CUD, such as those that target the endocannabinoid (eCB) system, must be developed in a manner consistent with these sex differences. The present pilot study sought to prospectively assess sex differences in cannabis withdrawal in a small sample of adults with moderate-to-severe CUD and to determine if withdrawal was associated with peripheral eCB and eCB congener tone...

BACKGROUND: The serotonergic neurotransmitter system is involved in many ethanol-induced changes, including many behavioural alterations, as well as contributing to alcohol dependence and its withdrawal. AIMS: This review has evaluated microdialysis studies where alterations in the serotonin system, that is, serotonin, 5-HT, or its metabolite 5-hydroxyindoleacetic acid, 5-HIAA, have been reported during different ethanol intoxication states, as well as in animals showing alcohol preference or not...

BACKGROUND: Autonomic symptoms in alcohol-withdrawal syndrome (AWS) are associated with a sympathetic driven imbalance of the autonomic nervous system. To restore autonomic balance in AWS, novel neuromodulatory approaches could be beneficial. We conducted a pilot trial with percutaneous auricular vagus nerve stimulation (pVNS) in AWS and hypothesized that pVNS will enhance the parasympathetic tone represented by a reduction of pupillary dilation in a parasympatholytic pharmacological challenge...

Anxiety is a critical component of the development and maintenance of drug addiction; however, anti-anxiety medications such as benzodiazepines and beta-blockers (β-adrenergic receptor antagonists) are not used for the treatment of substance use disorder, except for the management of acute withdrawal syndrome. Preclinical studies have shown that beta-blockers may reduce stress-induced relapse; however, the effect of beta blockers on the escalation and maintenance of drug intake has not been tested. To address this issue, we chronically administered the β-adrenergic receptor antagonist propranolol during the escalation or maintenance of cocaine intake in a model of extended access (6 h) to cocaine self-administration (0...

OBJECTIVES: Detoxification clinics manage acute intoxication and withdrawal from alcohol and other drugs. At discharge, patients are referred to treatment, yet many are readmitted to detoxification, creating a "revolving door" of discharges and admissions. This pattern disproportionately affects some groups such as Alaska Native and American Indian (AN/AI) people. The primary goals of this study are to: 1) test the effectiveness of a patient navigation intervention to increase rates of transition to alcohol treatment following detoxification, and 2) prevent readmission to detoxification within 12-months...

BACKGROUND: Symptoms of acute alcohol withdrawal like tremors, seizures and delirium are commonly treated with benzodiazepines and vitamins. When complaints are not reacting to this treatment, an alternative diagnosis must be considered. Although hypomagnesemia is present in at least 30 percent of the patients with alcohol dependence, it can provoke and maintain these complaints. CASE DESCRIPTION: We present a 43-year-old man with alcohol dependence, who shows neurological, muscular, and cardiac consequences of an undiagnosed hypomagnesemia...

BACKGROUND: Alcohol withdrawal syndrome (AWS) is associated with increased morbidity and mortality in the trauma population. Benzodiazepines (BZD) are standard of care for AWS; however, given the risk of delirium with BZDs and reports of BZD-refractory withdrawal, phenobarbital (PHB) has emerged as an alternative therapy for AWS. Safety and efficacy studies of PHB for AWS in trauma patients are lacking. Our aim is to compare a BZD versus PHB protocol in the management of AWS in trauma patients...

The study aimed to group acute symptomatic aetiologies of consecutive episodes of status epilepticus (SE) into different subcategories and explore their associations with clinical outcome. Aetiologies were firstly categorized as "acute", "remote", "progressive", "SE in defined electroclinical syndromes", and "unknown". Four subcategories of acute aetiologies were then defined: i) withdrawal, or low levels, or inappropriate prescription of antiseizure medications, or sleep deprivation in patients with pre-existing epilepsy; ii) acute insults to central nervous system (CNS) ("acute-primary CNS"); iii) CNS pathology secondary to metabolic disturbances, systemic infection, or fever ("acute-secondary CNS"); and iv) drug/alcohol intoxication or withdrawal...

A 40-year-old female with a history of chronic alcohol use disorder presented with an acute intractable left-sided headache for three days and progressively worsening unsteady gait requiring a wheelchair to ambulate. The patient had a history of chronic alcoholism since 2019 but reported abstinence since September 2021. One month after quitting alcohol, she experienced a sudden deterioration in bilateral extremity neuropathy, forgetfulness, difficulty writing, and severe mood swings, which continued to worsen until her presentation in July 2022...

BACKGROUND: The ventral tegmental area (VTA) is a dopaminergic brain area critical in the development and maintenance of addiction. During withdrawal from chronic ethanol exposure, the response of VTA neurons to GABA is reduced through an epigenetically regulated mechanism. A whole genome transcriptomic approach was utilized to investigate the underlying molecular mechanism of GABA hyposensitivity in VTA during withdrawal after chronic ethanol exposure. METHODS: We performed RNA sequencing (RNA-Seq) of the VTA of Sprague-Dawley male rats withdrawn for 24 hours from chronic ethanol diet as well as the VTA from control Lieber-DeCarli diet-fed rats...

BACKGROUND AND OBJECTIVES: Alcohol use disorder (AUD) is a significant public health concern, with underutilized effective treatments, particularly in special populations. This article summarizes the current evidence and guidelines for treating AUD in special populations. METHODS: This article is a literature review that synthesizes the latest research on AUD treatment for special populations. We screened 242 articles and included 57 in our final review. RESULTS: There are four food and Drug Administration-approved medications for AUD (MAUD): disulfiram, oral naltrexone, extended-release injectable naltrexone (XR-NTX), and acamprosate...

Baclofen may reduce the symptoms of alcohol withdrawal, as an alternative or as an adjuvant for benzodiazepines, but the available data are insufficient to support baclofen-assisted alcohol withdrawal. This study investigated the need for diazepam during acute alcohol withdrawal in patients receiving baclofen. In a single-blind, dose-dependent randomized controlled trial with three study arms, 63 patients with alcohol use disorder, starting in-patient benzodiazepine-assisted alcohol detoxification, were randomly assigned to receive placebo (n = 18), baclofen 30 mg/day (N = 20), or baclofen 60 mg/day (N = 25) for 7 days...

IMPORTANCE: Super-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthetic therapy or recurs on the reduction/withdrawal of anesthesia. Current clinical knowledge of the disease and optimal treatment approach is sparse. OBJECTIVE: To systematically assess clinical characteristics, causes, outcomes, prognostic factors, and treatment approaches for patients with SRSE. DESIGN, SETTING, AND PARTICIPANTS: In this systematic review and meta-analysis, all studies reporting adult patients (18 years or older) diagnosed with nonanoxic SRSE were considered for inclusion, irrespective of study design...

INTRODUCTION: Medical clearance for patients with primary psychiatric complaints presenting to the emergency department has been debated for decades. Emergency physicians have argued that clearance labs are unnecessary, yet psychiatrists may still order or require them. A retrospective review was conducted to evaluate the continued need for labs of psychiatric patients and help identify high risk groups that may need additional intervention prior to medical clearance. METHODS: Charts of 163 patients from Ochsner LSU Shreveport Psychiatric Crisis Unit (PCU) were reviewed with data collected of history, physical examination, review of systems, vitals and routine lab work including complete blood count (CBC), comprehensive metabolic panel (CMP), urine drug screen (UDS), serum ethanol level (EtOH), urinalysis (UA), creatine kinase (CK), urine pregnancy test (UPT), and rapid COVID-19...

The association of focal motor seizures with cerebral hemiatrophy is a recognised rare paediatric syndrome known as 'hemiconvulsion, hemiatrophy and epilepsy' (HHE). To date, HHE has not been reported in adults. We present four adult patients with striking similarities to HHE, following alcohol withdrawal in chronic alcoholics. We document the imaging findings in the acute and subacute phases, discuss the underlying mechanisms and present a hypothesis regarding the pathophysiology.

This study aimed to examine characteristics associated with discharge against medical advice from the hospital in alcohol withdrawal patients, supporting the work of hospital staff and Alcohol Care Teams and identifying characteristics that may help target patients most likely to discharge against medical advice. We used Hospital Episode Statistics Data to identify demographic and clinical variables and compare these in alcohol withdrawal patients who discharged against medical advice from hospital, compared with those who were discharged by the clinical team...

BACKGROUND: Delirium is an acute confusional state characterized by changes in the mental status, level of consciousness, impaired cognition, and inattention. It can develop within hours or days. Cortisol release from the hypothalamic-pituitary-adrenal axis (HPA) is vital for the host survival in stress. Biomarkers are used as an indicator of pathogenic processes or to assess the responses to a therapeutic intervention. To improve delirium recognition and care, investigators have identified possible biomarkers that may help in diagnosing individuals with delirium, assessing the severity of delirium...