Evaluation of IV Sodium Chloride 0.9% in Acute Alcohol Intoxication

This report presents a two-center, single-blind, parallel-group study conducted in Queensland, Australia, investigating the efficacy of intravenous 0.9% sodium chloride (saline) in treating acute alcohol intoxication in adults aged 18-50 years. The study compared a single bolus intravenous injection of 20 ml/kg of normal saline with observation alone in the emergency department. The primary objective was to determine if IV saline administration reduced the Emergency Department Length of Stay (EDLOS) and improved clinical outcomes. Results indicated that IV saline did not significantly reduce EDLOS or treatment time compared to observation alone. While a trend towards faster alcohol clearance was observed in the treatment group, it was not statistically significant. The study also assessed resource utilization, revealing a higher cost associated with the saline treatment group. The authors concluded that routine prescription of intravenous fluids for uncomplicated acute alcohol intoxication is not recommended, and that observation with periodic monitoring of blood alcohol levels should suffice for patient management. The study highlights the lack of evidence supporting the routine use of IV saline and suggests that it does not improve patient outcomes or reduce resource utilization.

Does the administration of intravenous Sodium Chloride 0.9% in
the acutely intoxicated adult promote alcohol clearance and
clinical improvement?

Introduction
With i.v. 0.9% sodium chloride solution (saline) is often used to ed patients with
acute alcohol intoxication to treat, despite the lack of evidence for its
effectiveness. The theory behind this practice is that the management of IV
normal saline solution not only the diuretic effect of alcohol acts, but could also
be a dilutional effect on the level of alcohol and its metabolites, degradation of
the neuro-depressive effects, 1 patients faster sober and therefore less time to
spend in the emergency room.
A small experimental study showed no differences in the prices of alcohol
clearance in patients with a 1-L-bolus of IV normal saline compared with those
who have not received this contribution. 3 In addition to physiological saline
solution intravenous hydration as a treatment for alcohol poisoning in the ED is
still not discussed in emergency medicine references in favour.
Despite the lack of evidence, alcohol - intoxicated patients are routinely
performed with normal saline intravenously in many EDS in the whole world.
Justification for the use should be examined to ensure that the health and
economic benefits outweigh the potential harms (e.g. Infections and fluid
overload 8).
Our primary objective is to evidence to be an area in which routine care variable
is available. The present study compares an intravenous bolus injection of
normal saline solution on weight (20 ml/kg) and the observation of the
observation alone in patients with acute uncomplicated alcohol poisoning, the
observation in an ed.
Method
This was a two centre, single-blind, parallel-group study in a Health service
district in Queensland, Australia. The study was carried out under Australian and
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New Zealand Clinical Trials Register Number 12611000938909 registered. No
changes have been made in the study.
This study was conducted both by the local institutional human research ethics
commission and the Queensland civil administrative court for the annulment of
the approval approved. A Patient Information sheet for each patient after
completion of the study. The patients were allowed, your consent can be
revoked.
The first hospital has a tertiary ED, maintenance of 570-bed major metropolitan
areas Teaching Hospital. The second hospital has an urban ED, maintenance, a
270-bed general hospital. The participation in the year 2011 was 67 000 and 50
000.
The study population consisted of adults aged 18 to 50 years, presented with
uncomplicated alcohol poisoning, the observation. Potential patients were
identified by the triage nurse and either by an emergency registrar or
consultants for the eligibility is checked. Demographic information, the
concomitant use of alcohol and other drugs used were taken from the patient
and the corresponding securities history of the accompanying person or
ambulance officer.
Study protocol
The doctor was available Not-Berater, Chancellor or residents. The doctor was
responsible for the collection and use of the series after randomization
numbered opaque envelopes (SNOSE), order of intravenous fluids,
haematological and biochemical tests, ongoing review and decision on the
discharge. The attending nurse was either a Registered Nurse (RN) or a marked
nurse trained to the observation data evaluation the alcohol intoxication (Oaai)
Tool to manage, 9. General intoxication, breath alcohol analyser machine and IV
Fluid.
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Eligible patients had either a single bolus intravenous injection of 20 ml/kg
isotonic saline infusion randomised, in combination with observation (treatment
group) or observation alone (monitoring). No placebo was used. The doctor
estimated weight of the patient if the patient was not in a position to do so. The
calculated total dose of IV normal saline solution was fed by a gravity, ventilated
intravenous drip chamber with air filter spike, hoses, and at least 20 gauge or
larger iv needle through a large peripheral vein.
Monitoring inventory from a monitored Bay, oxygen saturation, blood pressure
and heart rate. Hourly Glasgow Coma Scale 10 measurements and respiration
rate observations were made according to hospital protocol. Clinical
deterioration that resuscitation was as a persistent heart rate is above 110 rpm,
or a blood pressure less than 90/60 mmhg defined for at least 30 minutes
Data Collection:
Recruitment for the study was conducted between October 2011 and May 2012.
Each participant made analysis of breath alcohol levels and an intravenous
indwelling cannula was inserted unless the patient cooperative or also fighting
for the safe placement of a previous year needle. Routine complete blood count,
biochemical and serum ethanol levels have been collected. Breath of the
alcoholic strength would repeat at 2 am taken and at the dismissal. Patients were
also asked to voluntarily urine samples for the screening of cannabinoids,
amphetamines, opiates, cocaine and benzodiazepines. The patients were than
with other illicit drugs, if you either to or you have tested positive on a urine
drug screen approved classified.
End-point data for EDLOS and treatment time were on a data collection sheet
collected. Utilization of resources for the treatments of alcohol intoxicated
patients were taken by it - reported that staff and medical records (total number
of normal saline bags, needles and hose systems). The number and cost per type
of laboratory blood sample were ordered from the hospital pathology service
collected.
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All the participants were a referral to the drugs and alcohol brief intervention
team will follow at a later time. The participants to the self were dismissed with
the hospital internal rules and the Queensland guardianship action, regardless of
the study protocol deals with.
Data Analysis:
To a reduction of the edlos of 2 h with a significance level of 5% and an output of
80%, then a sample of 72 per group was required. This sample was selected on
the basis of local data, where the historical average duration of stay of patients
with a primary diagnosis of alcohol poisoning or as a secondary diagnostics
between November 2008 and November 2009 was a little over 7 hours (439
min). We hypothesized that the average length of stay of 2 hours to 319 Min. In
patients, the intravenous saline solution reduced.
Statistical analysis was performed using SPSS v17 (SPSS, Chicago, IL, USA). A
two-sided, unequal variance of the Student t-test was used to compare groups,
except in cases where the measurements in the rule is not a man Whitney-U-Test
was used instead, have been distributed. Pearson 2-Test was used to detectχ
differences in the proportions. Intent-to-treat analysis was used. No interim
analysis was performed. We assumed that all the missing data randomly missing
and you in the analysis of censored. This study was conducted on the Consort
Statement (http://Www.consort-statement.org).
Discussion:
We have found that a single 20 mL/kg bolus intravenous infusion of 0.9%
sodium chloride, together with the observation that not ed duration of stay of
patients with uncomplicated alcohol intoxication, compared with those who only
have been observed to reduce. Also the treatment of time was not significantly
changed by administration of liquids. The present study suggests that the
administration of intravenous fluids has no impact on the EDLOS, even if other
factors such as delays in the discharge will be taken into account.
The treatment with a 20 mL/kg intravenously 0.9% sodium chloride intravenous
solution does not lead to a significant clinical improvement of intoxication scores
in comparison with the observation alone. This is also in inconsistencies with the
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perception that intravenous fluids thought to the top' to enable faster patient
previously dismissed.
Our study showed a statistically significant difference on alcohol distance at 2
am. However, absolute and percentage breathe alcohol content (BAL) at 2 p.m.
showed greater acceptance of the BAL in the treated group compared to
observation group. However, change in BAL was a secondary endpoint and the
present study was not supplied with power by a difference to recognize. Even
with this trend of a faster decline in the BAL in the treatment group, our
attention was paid to the implementation of a real study with realistic criteria
that reflect the current practice. BAL is one of the considerations, but the entire
clinical level of intoxication and the presence of an adult guardian often
determine the decision for the discharge.
Comparison of the cost of the resources used, the treatment group uses a $31.92
more. This difference is due to the costs for the salt and the difference in the time
of the employees. Interestingly, when patients with alcohol intoxication were of a
purely without blood values or saline therapy. This could have saved an
additional $62.94 per patient. Provided that we have all our 3752 Alcohol -
similar presentations in 2011 without being observed that an intervention (for
the alcohol poisoning-related part of their presentation), our health district alone
could be in the year 2011 about a $356 000 have been saved.
Limitations:
The present study was conducted with similar groups at the baseline
randomized. However, the present study is not a placebo in the observation
group includes practical considerations. We have to real practices in which the
observation alone is a good option for drunken patients must be observed.
Similar was impractical for blind people or patients. A further restriction that is
outside the control of this research was to study the patients in the emergency
department at the time of the first presentation of the patient. There were times
when intoxicated patients were not in the present study because of other
patients, the urgent attention. 82 potentially eligible patients were not
considered for inclusion (Fig. 1). This was mainly due to the other clinical
priorities. This missed eligible patients had similar demographic data and EDLOS
as the patients were included in the selection is unlikely. The data collected for
the self - reported staff time from inaccuracies, on single deviations have
suffered self - perception of time. The logistics for the measurement of the exact
time spent with each patient is difficult in a real-life environment. Despite these
limitations, the present study is the first randomised study, with the real world
evidence of the use of previous year 0.9% sodium chloride for alcohol drunk
patient.
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Conclusion:
There is no evidence that in alcohol - intoxicated patients a bolus of IV normal
saline management, along with the observation that provides better results than
the patient-oriented monitoring alone. The use of needles, liquids and blood
samples take you time and resources that have no impact on the clinically
relevant results. Although both treatment scenarios in this study employs safe
and adequate, we do not recommend routine prescription of intravenous fluids
to patients with uncomplicated acute alcohol intoxication to shorten their
duration. Routine serum ethanol, complete blood counts and serum electrolytes
are in these patients is not indexed. BALs, with periodic monitoring of these
patients, should suffice to sobriety or safe for discharge.
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