Welcome to the Emergency Medicine Cases podcast. I'm your host, Dr. Anton Hellman,

bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

It turns out it's impossible to fake a tongue tremor at all.

We have many patients in my department who are still slurring and can barely lift their head

up who are asking for benzodiazepines.

Alcohol withdrawal is everywhere. We see over half a million patients in USEDs for alcohol

withdrawal every year. Despite these huge volumes of

patients and the diagnosis of alcohol withdrawal seeming relatively straightforward, it's actually

missed more often than we'd like to admit, being confused with things like drug intoxication or

of sepsis. Or it's not even on our radar when a little old lady presents with delirium.

The differential diagnosis is humongous, and no blood tests on the planet will help us

diagnose alcohol withdrawal. In fact, the diagnosis is entirely a clinical one.

What's even more surprising to me is that even if we do nail the diagnosis,

observational studies show that in general, alcohol withdrawal is poorly treated. Now, there's several

reasons for our all too often mismanagement of these patients. Few EDs have a standardized approach

or training of an approach to the management of alcohol

withdrawal.

There's unfortunately still a bit of a stigma associated with alcoholism in many EDs.

And the medications used to treat alcohol withdrawal are often dosed incorrectly.

Now, some of you might be thinking, well, so what if we miss alcohol withdrawal or

we don't treat it properly? Well, mismanaged alcohol withdrawal can be fatal. An untreated severe

withdrawal often ends up with your patient seizing or maybe a progression to delirium tremens

...