Below is a card from one of the first patients I treated for alcohol withdrawal. He lingered in the hospital for days on various benzodiazepine regimens (including a lorazepam infusion), and eventually limped home on an oral chlordiazepoxide taper. He wrote me a thank-you card days after leaving the hospital, but as you can see he still had a tremor:
We've come a long ways since then. Currently, phenobarbital monotherapy is replacing benzodiazepines as the front-line therapy for alcohol withdrawal at many institutions. Phenobarbital offers the ability to provide faster and more definitive therapy for alcohol withdrawal, while avoiding extended ICU stays for repeated doses of benzodiazepines. Although benzodiazpines (particularly IV diazepam) remain adequate for milder cases, this chapter focuses on phenobarbital as a more powerful and versatile approach.
The IBCC chapter is located here.
- The podcast & comments are below (Because the podcast is a true monster it's not ready yet. It will be out soon. If you're having an acute withdrawal reaction due to the lack of a podcast, you can watch the below video from a talk about phenobarbital I gave a couple years ago).
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- IBCC chapter & cast – Hemophagocytic LymphoHistiocytosis (HLH) - September 21, 2020
- IBCC chapter & cast –Gastrointestinal hypomotility in critical care - September 14, 2020
- IBCC chapter & cast – Cerebral Venous Thrombosis - September 7, 2020