All right, so welcome back to the Internet Book for Critical Care podcast. I'm here with Adam Thomas,

and we're going to talk about alcohol withdrawal. This is going to be a bit of a long one.

Josh, we're doing it. The hype on the Internet was out there. You consulted the Twittosphere,

and you made this comprehensive.

Straight up answered all the questions I would have as an Emerge Doctor Intensivist.

So we're going to get straight into it.

And yes, there's a case description of Porphyria.

So Josh has hit everything you want to know about on here.

So today, Big Sign Post, we'll talk about treatment with phenobarbital and why it's

money. We'll talk about the role of other drugs, special situations, and to polish it all off

that checklist when you see a patient in alcohol withdrawal. So the preamble here, because I'm a

zennial. There's some millennials out there. When we grew up in medicine, it was always benzos.

It was always benzos, Josh.

So why don't you walk me down memory lane and say something before our generation of physicians

that this is not always the case.

Yeah.

So historically, prior to around the 1970s to 1980s,

barbiturates were the frontline agent for alcohol withdrawal. And then

Benzos came along and they were the new hotness and they essentially replaced barbiturates. And

there was never any real evidence for that replacement. I've dug back and there's basically like

no RCTs. If anything, there's one trial that suggested maybe barbiturates were a bit better.

But long short, that was in the pre-evidence-based medicine era. There's a shift to benzodiazepines.

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