Internal Medicine (General Medicine)

Alcohol use disorder is a frequent occurrence within the United States, accounting for approximately 18% of the general population. Statistically, 50% of these people experience Alcohol Withdrawal Syndrome (AWS); a clinical diagnosis characterized by autonomic hyperactivity, following abrupt abstinence from heavy alcohol consumption. AWS is a life-threatening disorder that for many years has been treated with tapering doses of benzodiazepines— mostly chlordiazepoxide (CDE) and lorazepam (LOR). This paper seeks to answer the question “Are there better clinical outcomes when treating acute Alcohol Withdrawal Syndrome symptoms with chlordiazepoxide or lorazepam?”. A literature review was conducted to compile and analyze data from Randomized Clinical Trials (RCTs), and peer reviewed journal articles. These sources were carefully critiqued and compared for an overview to support the use of one benzodiazepine therapy over the other in AWS treatment. The revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale of alcohol withdrawal is the primary measure used to quantify and monitor improvement of AWS and treatment used. CIWA-Ar scalings, dosing regimens (length, doses, number of doses), days to resolution of symptoms, and adverse effects were compared across multiple studies to reach a conclusion. This paper concludes that the use of lorazepam can be more advantageous than traditionally accepted treatments due to its safety profile among patients with liver disease, promising abilities to decrease the time to complete resolution of symptoms, and a potentially easier transfer to sobriety.

When any fetal blood group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal-maternal bleeding may stimulate an immune reaction in the mother Maternal immune reactions also can occur from blood product transfusion. The formation of maternal antibodies, or"alloimmunization,' may lead to various degrees of transplacental passage of these antibodies into the fetal circulation. Depending on the degree of antigenicity and the amount and type of antibodies involved, this transplacental passage may lead to hemolytic disease in the fetus and neonate. Undiagnosed and untreated, alloimmunization can lead to significant perinatal morbidity and mortality. Advances in Doppler ultrasonography have led to the development of noninvasive methods of management of alloimmunization in pregnant women. Together with more established protocols, Doppler ultrasound evaluation may allow for a more thorough and less invasive workup with fewer risks to the mother and fetus. Prevention of alloimmunization is addressed in another Practice Bulletin