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Teachable Moment
April 27, 2020

Challenges in Prediction, Diagnosis, and Treatment of Alcohol Withdrawal in Medically Ill Hospitalized Patients: A Teachable Moment

Author Affiliations
  • 1Department of Medicine, Dalhousie University, Halifax, Canada
  • 2Department of Medicine, University of British Columbia, Vancouver, Canada
  • 3British Columbia Centre on Substance Use, St. Paul’s Hospital, Vancouver, Canada
JAMA Intern Med. 2020;180(6):900-901. doi:10.1001/jamainternmed.2020.1091

An older man was admitted to the hospital for planned bowel resection. He reported drinking 8 to 10 ounces of whiskey daily for many years. During previous hospitalizations, he had no documented alcohol withdrawal symptoms or seizures. His last drink was 3 days prior to admission.

Over the first week postoperatively, he had no symptoms of alcohol withdrawal. On postadmission day 6 he developed an anastomotic leak, requiring urgent reoperation and antibiotics. On postadmission day 9, he became acutely disoriented and inattentive, with new abdominal tenderness. Imaging showed large intra-abdominal abscesses, and percutaneous drains were placed. His heart rate and blood pressure remained normal.

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