#212 Sober Talk: Managing Inpatient Alcohol Withdrawal with Joji Suzuki, MD

Summary Crush those 11 pm “STAT: Patient agitated” pages with this expert guide to assessing for and treating alcohol withdrawal! Dr. Joji Suzuki MD, addiction psychiatrist extraordinaire at the Brigham and Women’s Hospital, walks us through how to think about the risk of severe withdrawal, the different ways to manage it, and how to engage with patients as they’re leaving the hospital. In the course of this Car-Talk (well, not exactly the same as the critically acclaimed radio show, but he did record in his car….), Dr. Suzuki demystifies withdrawal and debunks some common myths: that we must manage withdrawal inpatient, that banana bags are the cure to a hangover and alcoholic malnutrition, and that we tend to under-medicate with benzos (actually, it’s the opposite!).

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Credits Written and Produced by Nora Taranto MD Infographic and Cover Art by: Nora Taranto MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Cyrus Askin MD, Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Joji Suzuki MD

Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.

Time Stamps 00:00 Intro, disclaimer, guest bio 02:52 Guest one-liner; Career advice; Picks of the Week*: Why We Do What We Do (book); Fargo (film) 08:10 A Case from Kashlak and Screening for Alcohol Use and Severe Withdrawal Risk 17:32 Outpatient Versus Inpatient Treatment 25:27 Gabapentin for alcohol withdrawal 27:10 Indicators for ICU level Care 31:53 Symptom-Driven versus Fixed-Dose Protocols , Benzos vs. Barbs 36:55 And which benzo? 39:47 A Natural History of Withdrawal 44:10 Banana Bags and Thiamine Deficiency 48:17 The Transition Home: Naltrexone, Bridge Clinics, and Motivational Interviewing 56:36 Outro and Bonus clip

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal Listeners will be able to screen patients for risk of alcohol withdrawal and decide on management strategies that are individualized to the patient.

Learning objectives After listening to this episode listeners will…

Screen and identify for patients at high risk of withdrawal Identify who would benefit from inpatient withdrawal, and ICU vs floor level care Identify the best withdrawal management protocol List indications and contraindications of first line therapy for alcohol use disorder.

Disclosures Dr Suzuki reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation Suzuki J, Taranto NT, Williams PN, Askin C, Watto MF. “#212 Sober Talk: Managing Alcohol Withdrawal with Joji Suzuki, MD”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/episode-list May 7, 2020.