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With the celebration of St. Patrick’s Day this month, there will be the inevitable few who drink enough alcohol to require medical attention. Some will show up in your emergency department for treatment, but what kind of treatment should they receive?
"First and foremost is attention to respiratory support. Patients are given oxygen, if it’s required, and the nurses make sure patients don’t aspirate if they are vomiting. At that point, most of our intoxicated patients are given a banana boat,’ which consists of 1 L of normal saline, with 10 mL multivitamin, and 100 mg thiamine," says Rhonda Beene, RPh, of Health Midwest Hospital in Lee’s Summit, MO.
Reasons for IV fluids vary
Why are these patients treated with intravenous fluids? As is the frequent answer in medicine: It depends. Some would say it’s to correct volume depletion and thus also correct hypotension. In the "banana boat," the components are given to correct volume depletion caused by vomiting (normal saline), help correct nutrition depleted by vomiting and/or chronic drinking (multivitamin), and prevent Wernicke’s encephalopathy (thiamine). (Patients who are thiamine-deficient can experience sudden onset of Wernicke’s encephalopathy following administration of glucose.) Often, if a patient receives dextrose, it’s to correct hypoglycemia that alcohol can induce. Still others contend that IV fluids are administered to speed the time to sobriety by increasing the clearance of the drug.
|Ethanol Content of Drinks|
|Ale and special beers||up to 12%|
|Distilled drinks||35-55% or|
|(e.g., rum, whiskey, liqueurs)||as much as 95%|
|Source: Adapted from Applied Therapeutics, 5th ed.1|
Certainly, IV fluids are appropriate in some intoxicated patients. However, not all of those patients require it. Although the cost to supply the drug is not great in this case, the cost of supplies and personnel required to give an IV is enough to make the health care team consider whether every intoxicated patient needs an IV.
Ethanol is oxidized at an approximate rate of 15 mg/dL/h in men and 18 mg/dL/h in women.1 It takes time to "sober up," and time might just be what the doctor ordered. Pharmacists can help review and evaluate IV use in their hospitals. While some intoxicated patients may require a good deal more care than described here, still others may not even require a "banana boat."
1. Buchanan JF, Joe G, McKinney HE. "Alcohol Abuse." In: Koda-Kimble MA, Young LY, eds. Applied Therapeutics: The Clinical Use of Drugs. 5th ed. Vancouver, WA: Applied Therapeutics, Inc.; 1992, pp. 60-1-60-14.
2. Li J, Mills T, Erato R. Intravenous saline has no effect on blood ethanol clearance. J Emerg Med 1999; 17:1-5.