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895: ENTERAL VERSUS INTRAVENOUS PHENOBARBITAL BOLUS DOSING FOR ALCOHOL WITHDRAWAL SYNDROME

Introduction/Hypothesis: The purpose of this study was to determine if a difference in clinical outcomes exists for patients given an enteral bolus dose of phenobarbital (PHB) vs. those given the standard intravenous (IV) bolus dose for the treatment of Alcohol Withdrawal Syndrome (AWS). Methods: This study was an IRB approved, retrospective cohort conducted at a 515-bed tertiary care hospital. Patients admitted between April 1, 2017 and October 1, 2018 were screened for inclusion. Included patients were 18 years of age or older with a diagnosis of AWS, were initiated on the PHB protocol within 24 hours of hospital admission, received either an enteral or IV bolus dose of PHB, and were a medical intensive care unit (MICU) patient during the admission. Patients were assigned 1:1, to either the enteral or IV PHB group. The primary outcome was MICU length of stay (LOS). Secondary outcomes included total hospital LOS, total PHB dose, need for adjunctive agents for AWS symptom control, and adverse events including mechanical ventilation or withdrawal seizures. Results: After retrospective chart review 32 patients were included in the study, 16 in each group. No difference in median MICU LOS was seen between groups (2 days [2-2.25] vs. 2 days [12.25]). However, the IV group was observed to have a one day difference in median total hospital LOS (4 days [3-5.25] vs. 3 days [3-3.25]). The enteral PHB group received a lower initial bolus dose (194.4 mg vs. 260 mg), however the median total PHB dose was similar between groups (1069 mg [915-1166] vs. 1038 mg [908-1133]). The number of patients requiring adjunctive agents was similar between groups (15 vs. 16), and no events of mechanical ventilation or withdrawal seizures were documented in either group. Conclusions: This was a pilot study to explore the concept of enteral PHB bolus dosing in AWS. Overall, the enteral and IV groups were numerically similar in most outcomes including MICU LOS, total PHB dose, need for adjunctive agents, and adverse events. The IV group did trend toward shorter hospital LOS, however if this study were repeated with a larger sample size different results might be observed. Although future studies are necessary, these results indicate that enteral PHB bolus doses may be a safe and effective alternative in the treatment of AWS.