Alcohol Withdrawal Syndrome: Outpatient Management.

Approximately one-half of patients with alcohol use disorder who abruptly stop or reduce their alcohol use will develop signs or symptoms of alcohol withdrawal syndrome. The syndrome is due to overactivity of the central and autonomic nervous systems, leading to tremors, insomnia, nausea and vomiting, hallucinations, anxiety, and agitation. If untreated or inadequately treated, withdrawal can progress to generalized tonic-clonic seizures, delirium tremens, and death. The three-question Alcohol Use Disorders Identification Test-Consumption and the Single Alcohol Screening Question instrument have the best accuracy for assessing unhealthy alcohol use in adults 18 years and older. Two commonly used tools to assess withdrawal symptoms are the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale. Patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal should be treated as outpatients when possible. Ambulatory withdrawal treatment should include supportive care and pharmacotherapy as appropriate. Mild symptoms can be treated with carbamazepine or gabapentin. Benzodiazepines are first-line therapy for moderate to severe symptoms, with carbamazepine and gabapentin as potential adjunctive or alternative therapies. Physicians should monitor outpatients with alcohol withdrawal syndrome daily for up to five days after their last drink to verify symptom improvement and to evaluate the need for additional treatment. Primary care physicians should offer to initiate long-term treatment for alcohol use disorder, including pharmacotherapy, in addition to withdrawal management.

PURL: Can viscous fiber lower glycemic markers in type 2 diabetes?

The first meta-analysis to focus on viscous dietary fiber in T2D suggests a potential role for this supplement in improving glycemic control.

Exertional rhabdomyolysis: a case series of 30 hospitalized patients.

INTRODUCTION: Exertional rhabdomyolysis is a clinical entity of significant muscle breakdown in the setting of exercise. However, clinical course and discharge criteria, once hospitalized, are poorly described. We describe 30 cases of exertional rhabdomyolysis and their hospital course. METHODS: Thirty hospitalized cases with ICD-9 code of 722.88 (rhabdomyolysis) as the primary diagnosis were reviewed from 2010 to 2012. We excluded those with associated trauma, toxin, and heat illnesses. RESULTS: The average length of stay was 3.6 days (range: 1-8 days). Length of stay correlated significantly with peak creatine kinase (CK) levels. The mean admission CK was 61,391 U/L (range 697-233,180 U/L). The mean discharge CK was 23,865 U/L with a wide range (1,410-94,665 U/L). Six cases (20%) had evidence of acute kidney injury, but most had serum creatinine (Cr) <1.7 mg/dL. One had a peak Cr of 4.8 mg/dL. Higher serum Cr levels correlated significantly with lower CK levels. Twenty-nine out of 30 patients were discharged when CKs downtrended. CONCLUSION: Higher peak CK levels predicted longer length of stay. Higher serum Cr significantly correlated with lower CK levels. There did not appear to be any threshold CK for admission or discharge, however, all but one patient were discharged after CK downtrended.