• Farnaz Vahidnia, Jonathan Rosenson, Carter Clements, Barry Simon, Jules Vieaux, Sarah Graffman, Bitou Cisse, and Harrison Alter.
• Department of Emergency Medicine, Alameda County Medical Center/Highland Hospital, 1411 E. 31st Street, Oakland, CA 94602, USA.
• J Emerg Med. 2013 Mar 1;44(3):592-598.e2.

BackgroundAcute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management.ObjectiveWe investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal.MethodsThis was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward).ResultsThere were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4-32). There were no differences in adverse events.ConclusionsA single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes.Copyright © 2013 Elsevier Inc. All rights reserved.

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