{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:55:05Z","timestamp":1787165705722,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T00:00:00Z","timestamp":1325808000000},"content-version":"vor","delay-in-days":919,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2009,7]]},"abstract":"<jats:p>Alcohol withdrawal syndrome (AWS) is a major cause of morbidity and mortality in the acute care setting. We describe a 28\u2010year\u2010old man who was brought to the emergency department with a new\u2010onset seizure and clinical signs and symptoms consistent with advanced delirium tremens. A symptom\u2010triggered intensive care unit treatment protocol consisting of a benzodiazepine and antiadrenergic agents was started. The manifestations of delirium tremens persisted with titration of a lorazepam infusion in excess of 40 mg\/hour. Intravenous phenobarbital was administered in escalating doses of 65 mg followed by 130 mg 15 minutes later, resulting in control of severe agitation in the face of benzodiazepine resistance. Subsequent scheduled phenobarbital administration allowed for a successful and orderly weaning of the continuous benzodiazepine infusion and adjunctive agents used in AWS management. With continued clearing of consciousness, the patient was successfully discharged. The administration of phenobarbital in this patient allowed improved symptom control, minimized the potential for propylene glycol toxicity, was not associated with respiratory depression, and facilitated successful weaning of benzodiazepines. Barbiturates offer a mechanism of action that is different from that of benzodiazepines. Although the cornerstone of treatment for AWS remains benzodiazepines, this case highlights the potential utility of phenobarbital in patients with resistant AWS.<\/jats:p>","DOI":"10.1592\/phco.29.7.875","type":"journal-article","created":{"date-parts":[[2009,6,26]],"date-time":"2009-06-26T11:29:35Z","timestamp":1246015775000},"page":"875-878","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Phenobarbital Treatment in a Patient with Resistant Alcohol Withdrawal Syndrome"],"prefix":"10.1002","volume":"29","author":[{"given":"Christopher E.","family":"Hayner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy L.","family":"Wuestefeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela J.","family":"Bolton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,1,6]]},"reference":[{"key":"e_1_2_1_2_2","volume-title":"UptoDate","author":"Hoffman R.S.","year":"2008"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1124\/mol.63.1.53"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000256841.28351.80"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-199101000-00006"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(87)80520-6"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200107000-00012"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1989.tb00737.x"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2107138"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.13.1405"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra020617"},{"issue":"3","key":"e_1_2_1_12_2","first-page":"2","article-title":"ADR prevent\u2010ERR: IV lorazepam infusion and propylene glycol toxicity","volume":"11","author":"Institute for Safe Medication Practices","year":"2006","journal-title":"ISMP Med Safety Alert"},{"key":"e_1_2_1_13_2","volume-title":"Toxicological evaluation of certain food additives with a review of general principles and of specifications: 17th report of the Joint FAO\/WHO expert committee on food additives","author":"World Health Organization","year":"1974"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.2006.26.1.23"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1G083"},{"key":"e_1_2_1_16_2","first-page":"361","volume-title":"Goodman & Gilman's the pharmacological basis of therapeutics","author":"Hobbs W.R.","year":"1996"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-008-9065-z"},{"key":"e_1_2_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(97)90577-1"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1L186"},{"key":"e_1_2_1_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02043479"},{"key":"e_1_2_1_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1978.tb06930.x"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1592%2Fphco.29.7.875","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1592\/phco.29.7.875","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T13:01:17Z","timestamp":1761051677000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1592\/phco.29.7.875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,7]]},"references-count":20,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2009,7]]}},"alternative-id":["10.1592\/phco.29.7.875"],"URL":"https:\/\/doi.org\/10.1592\/phco.29.7.875","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,7]]},"assertion":[{"value":"2012-01-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}