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GRACE-4 is packed with practice-changing recommendations for patients with alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS).
GRACE is back, this time slightly shorter than your favorite sci-fi novel
Folks, this was a massive tome. We are going to break it down, but this guideline summary is a bit longer than usual. It answers 3 PICO questions:
1) Does adding phenobarbital to benzodiazepines in AWS improve outcomes?
2) Does prescribing anti-craving medications improve outcomes in AUD?
3) Is there benefit to treating CHS with dopamine antagonists or capsaicin?
This document consists of 7 recommendations and is full of pearls and pitfalls, and I would highly recommend reading it yourself. Below are the recommendations, selectively quoted.
How will this change my practice?
AWS: Adding phenobarbital to benzodiazepines in moderate to severe patients is something I’ll advocate for at my institution.
AUD: I had no idea I was so bad at treating this! I’ll be prescribing naltrexone or acamprosate – rarely gabapentin – as outlined in the algorithm.
CHS: I’ll continue to use droperidol as my first line antiemetic in patients with suspected CHS and continue to prescribe capsaicin cream. I will try to order capsaicin and see if it’s feasible in my hospital system.
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