S2 Ep5: #16 Distilling Inpatient Alcohol Withdrawal with Dr. Shawn Cohen

The Curbsiders Addiction Medicine Podcast

Distill the management of inpatient alcohol withdrawal down to its core with Dr. Shawn Cohen (@ShawnCohen_MD, Yale University). This episode is full of practical pearls, and we discuss the ins and outs of managing alcohol withdrawal in the hospital setting. Learn how to triage patients in the hospital, which benzodiazepines to select, the pathophysiology of alcohol withdrawal, and phenobarbital for the management of alcohol withdrawal.
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Credits

• Producer, writer, show notes, cover art, and infographic: Zina Huxley-Reicher, MD
• Hosts: Carolyn Chan, MD and Zina Huxley-Reicher, MD
• Reviewer: Payel Jhoom Roy, MD, MSc
• Showrunner: Carolyn Chan, MD
• Technical Production: Podpaste
• Guest: Dr. Shawn Cohen

Show Segments

• Intro 0:00
• Guest bio - 3:17
• Case 1- 5:20
• Alcohol withdrawal pathophysiology - 6:10
• Kindling effect - 9:05
• Diagnosing alcohol withdrawal and clinical withdrawal scales - 10:12
• Severe alcohol withdrawal definition - 15:26
• Triaging a patient - 16:50
• Medication management for alcohol withdrawal syndrome- 19:37
• Decisions between benzodiazepines and phenobarbital and formulation - 23:47
• Choices of benzodiazepines in hepatic impairment - 26:30
• Symptom triggered vs. fixed protocol - 28:10
• Benzodiazepine resistant alcohol withdrawal - 33:33
• Timeline of alcohol withdrawal syndrome symptoms - 42:38
• ICU management of alcohol withdrawal - 46:27
• Discharge planning and management of alcohol use disorder - 48:50
• Take home points - 51:45
• Lightning round- 53:43
• Outro - 56:01