# IV Saline for Hangover prevention/solution



## Jon

Ok folks... I'm going to raise a hot button issue here...

Growing up in EMS, and spending lots of time with medics, I've heard LOTS of stories about EMS providers using IV fluid as either prophylaxis or treatment for a hangover. When I was in Baltimore for the EMS conference, the issue came up and I heard some perspective I hadn't heard before.

Now--- the big question:

Is it appropriate for an ALS practitioner to use IV fluid to treat dehydration... specifically hangovers? Is it appropriate at work? Is it appropriate at home?

Does your agency have any policies preventing it?

WHY?




Oh.. and just a little warning - *PLEASE *REMEMBER that whatever you post is indexed on _*Google*... _so don't post anything here that you wouldn't want your boss to someday find.


----------



## bassman1490

i know someone who was just let go because he did this exact thing, im not sure on details, so i dont know if it was at work or at home


----------



## jordanfstop

Hm.. At work? The good side of me wants to say "shouldn't have been at work hungover!" The skell side of me wants to say "I don't see a problem with it.. as long as you take the line out of you before a call." (I've actually ridden with somebody who has had a litre of bag in him at work. He dc'd the bag before the call, but kept the line in and just put some 4" roller gauze over it and took it out during txp with a pt.

At home? Not sure.


For that ultimate hangover, some will do a "banana bag" with an amp of D50 infused into NS.

(The banana bag contains B12, thiamine(B1) and folic acid(B9), sometimes magnesium sulfate.)


----------



## MasterIntubator

Is it appropriate?  Yes, the pt can benefit from that.

Is it appropriate at work or at home? ( for personal use/non-transport ) No.  That is called practicing medicine without the direct supervision of a physician, and if I am not mistaken, is a federal law.

We do have a policy stating that, becuase back in the 90s our medical director heard of that practice going on and he wanted to reiterate the law to us, that the practice under his license is unacceptable. 

Just FYI:  On most of our medical equipment, this message is posted: " Federal Law restricts this device to sale/use by or on the order of a physician."
This goes for any oxygen device, IV fluids, ashman chest seal, etc.... that bears that label.

Do I agree with it?  Not always.  But running the risk of loosing my license for starting an IV in a hung over friend just because he could not control his drinking habits.... naaaaa.  Not me.  He/she may feel like dying, but he wil be just fine.


----------



## MSDeltaFlt

Is it appropriate for a pt on a call?  Yes.  LR's better than saline.

Is it appropriate for a coworker not on a call?  Hell no.  If you show up for work and "pee hot", you go home along with your partner who's trying to help you cover it up.  And make sure both of your CV's are up to date while your there.  You should have plenty of time.

If my partner is hungover, he/she is no good to me.


----------



## TKO

I remember a lot of students who would take home expired saline and some other supplies to practice, and while it is officially discouraged on one hand it is also admirable on the other.

Who bothers with IV anyway?  Why waste the time just to look cool?  Drink a glass of water instead, for all the good it will do you.

Want to beat a hangover?  IV and O2 isn't the best solution.  Prepare the night before: before calling it a night, have 2 tylenol and a multivitamin beside your bed and a high-carb meal, like a meatball sub in the fridge.  Consume when you get home with several glasses of water or milk (think about alcoholic ketoacidosis!).  Then crash.

Wake up about 2 hours before you need to, urinate and then consume a gatorade and go back to bed.  Wake up and shower in cool water.

Your as good to go as any other morning.

Oh, and one last point, and it is very important: for every drink that you have, you will require 1 hour of sleep to match it.  Otherwise if you go to bed at 5 AM with a bloodstream full of fresh alcohol, no hangover cure will help you at 7:30.

Unless you try Narcan, but as I've never given it to a drunk and never disliked my career enough to be so wreckless as to be a guinea pig so I can't speak to its effectiveness.  I've heard debates both ways though.  Alcohol is a class IV narcotic and there are clinics that tout its usage for treating alcoholics with DT, but I just don't know because this is one where the proof is in the putting.


----------



## mikie

So does the Saline aid in ridding of the hangover?  How would that work?  (an honest question)

And for the drunk pt, would the saline help 'prevent' a hangover, or more for fluid 'replacement?' (I'm not sure on the correct term...)

Thanks !  (interesting topic, I've always wondered myself)


----------



## emtwacker710

bassman1490 said:


> i know someone who was just let go because he did this exact thing, im not sure on details, so i dont know if it was at work or at home



yes, I know who you are talking about, it is against the rules at pretty much all the squads in our EMS council


----------



## KEVD18

a big part of a hangover is electrolyte imbalance and dehydration. while a liter of isotonic saline will aid in teh correction of the dehydration(although as previously mentioned, not significantly better that po fluids), its really more of a placebo/cool guy routine.


----------



## TKO

yeah, it is really no advantage to a conscious person over a couple of salty crackers and a few cups of water or a large gatorade.  But if you were to place a saline lock before going out and tipping at windmills and then starting a bag before going to bed, then there would be more noticable benefits.  Personally, I would rather set my alarms to go off every other hour, roll over to turn them off and drink a glass of water at the same time.

There's quite a lot that happens during alcoholic consumption that leaves the body feeling gawd-awful the next day.  Dehydration, electrolyte imbalance, hypoglycemia, excess calcium channeling, decreased bioenergetics d/t ineffective Krebbs cycles, etc.

An IV won't fix that alone as you can guess.  Water, gatorade, high-carb meal, multivitamin, tylenol and plenty of sleep would be the prescribed fix.


----------



## VentMedic

MSDeltaFlt said:


> Is it appropriate for a coworker not on a call?  Hell no.  If you show up for work and "pee hot", you go home along with your partner who's trying to help you cover it up.  And make sure both of your CV's are up to date while your there.  You should have plenty of time.
> 
> If my partner is hungover, he/she is no good to me.



Darn straight on that!


----------



## Ridryder911

Come in with a hang over.. your drunk .. period. You can either go home voluntarily, or pee in a cup and take the consequences. Start an IV, sure for off duty personal.. (yes, we have a standing order for dehydration, etc. for our own personal). 

Sorry, it is time for our profession to be such.... a profession. That means we act and perform as such. 

R/r 911


----------



## Ops Paramedic

Nope, not on my watch!  Unless the alcohol was unwillingly funneled down your throat, it was all self induced, and therefore the hangover is also all yours.  As for having alcohol in your system when coming on duty, thats a defenite no-no, and instant dismisal is the path that will be followed...


----------



## bassman1490

hey james u know the man better than i did, was it at home or during work, and i feel you shouldnt be coming into work with a hangover anyways because its not professional and it is against the rules in our area


----------



## BruceD

Hey guys, be careful about mixing tylenol and alcohol.  Those do NOT mix.
When you take acetaminophen, it is conjugated in the liver by CYP450s (especially 2E1).  After conjugation, a part of acetaminophen is hydroxylated forming a highly toxic metabolite (N-acetylbenzoiminoquinone : had to look it up  ). 

Under normal circumstances: This (N-ac.) reacts with glutathione producing a harmless glutathione adduct.
Under EtOH:
1st- EtOH increases metabolism of Acetaminophen by up regulating CYP450-2E1, therefore increasing the dose of the toxic metabolite (N-ac.).
2nd- This can rapidly deplete hepatic glutathione, leaving the toxic metabolite to build up, causing hepatic necrosis with a 10-20% mortality rate. (it binds covalently to sulfhydryl groups of hepatic proteins). In chronic alcoholics, this has been seen with administration of as few as 3 extra-strength tylenol.




> Alcohol is a class IV narcotic and there are clinics that tout its usage for treating alcoholics with DT



I'm not sure how it is classified elsewhere, but in the U.S. I don't believe alcohol is technically a narcotic, as it works at the GABA & NMDA receptors and is not a derivative of the opium plant.

Please correct any errors!
Stay Safe guys
-B


----------



## TKO

No need for correction if you are right, and you may be, I should have been more aware that legal definitions aren't as relevant here as medical definitions (my bad!).  

I don't have my Mosby's textbook around so I can't cite anything.  I just remember the discussion back in school regarding if alcohol were discovered today, it would be a class IV narcotic that would require a prescription.  Also the followup discussion on effects of Narcan on Alcohol suggested that there was no analogous evidence to backup either outcome, but that known rehab clinics were using it against DTs.  So I guess only Chevy Chase knows for sure.


----------



## AnthonyM83

TKO said:


> yeah, it is really no advantage to a conscious person over a couple of salty crackers and a few cups of water or a large gatorade.


One would think an IV would be be faster acting and can also be left dripping overnight. No one's saying it's an instant cure, but it makes sense theoretically. I've never tried it, but do know a number of people who would give great testimonials.

I've also wondered...would it really be outside your scope? You're allowed to treat yourself, right? If you meet criteria for dehydration...

PS I think I heard rumors of a number of people getting in trouble for doing that during an nursing convention...not sure what the basis was


----------



## BruceD

TKO said:


> No need for correction if you are right, and you may be, I should have been more aware that legal definitions aren't as relevant here as medical definitions (my bad!).


Don't take anything I say as gospel  think of me as a... tourist!



> I don't have my Mosby's textbook around so I can't cite anything.  I just remember the discussion back in school regarding if alcohol were discovered today, it would be a class IV narcotic that would require a prescription.


I've also heard that it would be a very controlled drug.



> Also the followup discussion on effects of Narcan on Alcohol suggested that there was no analogous evidence to backup either outcome, but that known rehab clinics were using it against DTs.  So I guess only Chevy Chase knows for sure.


I think people in the room with me were worried.. I just had to LAUGH about the chevy chase comment 

There is apparently evidence that naltrexone can reduce alcohol consumption (its very chemically related to narcan, which is naloxone).  
From what I can see, it reduces the interaction of natural opiods with their receptors in the brain, reducing the feeling of well-being chronic alcoholics get when they drink.
So, it doesn't really affect alcohol effects drink by drink (so, no effect on a hangover for example), but reduces the overall, longer-term urge to drink, therefore adding more ability for them to control their problem.

Ref: http://ncadi.samhsa.gov/govpubs/bkd268/28c.aspx
Ref: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1087493


 And I'm still laughing at the chevy chase comment


----------



## BruceD

AnthonyM83 said:


> I've also wondered...would it really be outside your scope? You're allowed to treat yourself, right? If you meet criteria for dehydration...



Not trying to pick on Anthony, just the most recent post I saw.

This is just sort of how I see it.
Administering NS for dehydration is done (at least here) through the standing orders of the medical director.  Which is why we don't have to literally call in and ask permission to spike a bag.
The standing orders are what allows an emt/paramedic/etc to interact with patients using a substance or item that is supposed to be prescribed by a physician.
Logically, you have to follow one of two routes:
You are a patient of the medical director using the paramedic as his surrogate.  If you are a patient, there should be a patient care report.  If nothing else, it can be marked 'refused transport' I suppose.  I suppose if this occurred, you might receive a bill for services rendered...
Without a PCR, you are not a patient under the medical director and therefore are using prescription items without a prescription.


As for being allowed to treat yourself, I don't have a problem with that, but it seems like once you start using controlled items/drugs to do so, you've gotten into a problem.  
I'm sure there would be questions flying all over the place if a doctor walked into a pharmacy with his prescription pad and started ordering a handful of this and a handful of that to take for himself. 

As for the nurses that got in trouble at a convention for doing this, I am not familiar with the instance, but I myself would be quite angry if it was me that was paying for NS for patients and found out it was being used to treat irresponsible drinking. (no, I don't work hospital/ems admin, it's just an example).


----------



## TKO

Perhaps I should have suggested that Amy Winehouse would know for sure, and then they would have caught the reference.  But good comedy requires a solid pop-cultural reference, as any two-bit wise *** can pick on Lindsay Lohan.  Comparatively, Chevy Chase vs either of those two, and Chevy is going to stand the test of time as a classic alcoholic.

heh.


AnthonyM83 - as I was saying, for the Cx person, IV has no tremendous benefit.  Asleep, a person can be treated through the night.  But then there's the disadvantage that you have an IV in your arm and maybe the consequences that follow.  Awake, there isn't much need for poking holes in yourself if you have a healthy stomach as the fluids you consume will make their way into the bloodstream shortly after.

Salty water in the veins is NOT a cure for a hangover.  It will only address the dehydration symptoms, just as drinking several cups of water and eating some salty crackers will do.

I suspect that we need a gov't grant to make an official record of this.


----------



## AnthonyM83

I'll offer myself as a test subject for that study, then. For the greater good.

But seriously, there does seem to be a conflict between the theory of how well NS would work and with how well it actually does work (aka brings relief). I'm not familiar with the abbrivation "Cx", btw.

Bruce, as far as I know, it's completely okay for physicians to walk into a pharmacy with a stack of their own prescriptions. If they were opiates that would be different, that would send red flags, but same with a medic. Saying it's starting down the wrong road is a bit dramatic...once day he's giving himself NS, next he's shooting fentanyl... One's straight unethical, another is just using practical supplies from work. Only crime would be misappropriation of supplies (unless they used expired bags).


----------



## BruceD

AnthonyM83 said:


> Saying it's starting down the wrong road is a bit dramatic...once day he's giving himself NS, next he's shooting fentanyl...


 hahaha I'm don't believe I was implying normal saline was a gateway drug.

They teach doctors that they should not self-diagnose and it is not in the best interests of anyone to treat their own family members. (No time to pull up references, but you can find it).


----------



## firecoins

BruceD said:


> hahaha I'm don't believe I was implying normal saline was a gateway drug.



Sure it is. All the kids start a line and do Normal Saline.  Than they get hooked. Before you know it, kids are having vomit contests after a spoon ipneac (sp)


----------



## TKO

I got hooked on O2 in school.  Even to this day I can't make it more than a few minutes without a few puffs of second hand O2.

Cx = Conscious


----------



## katgrl2003

TKO said:


> I got hooked on O2 in school.  Even to this day I can't make it more than a few minutes without a few puffs of second hand O2.



Ok, that's downright funny.

-Kat


----------



## Jon

firecoins said:


> Sure it is. All the kids start a line and do Normal Saline.  Than they get hooked. Before you know it, kids are having vomit contests after a spoon ipneac (sp)


http://www.zippyvideos.com/211129792726595/family_guy_puke/


----------



## BruceD

TKO said:


> I got hooked on O2 in school.  Even to this day I can't make it more than a few minutes without a few puffs of second hand O2.
> 
> Cx = Conscious



I agree, the overuse of this extremely addictive, pervasive drug (some estimates put it at > 95% of the adult population and > 98% of children currently use!) and the horrible side effects it evokes must be brought to the public's attention.  We must not let one more victim fall prey to oxygen's inescapable physical and psychological dependance.  Perhaps if everyone contacted their local politicians we could finally make progress in the war on this lethal chemical.

Join "Paramedics against Oxygen Overuse in People" today!

After this drug is defeated, we'll proceed onto battle dihydrogen monoxidase, which may perhaps be responsible for more deaths throughout history than any other known chemical.


----------



## TKO

Wait!  I thought if we were to leave the ball and chain of Oxygen behind we would finally be free to exist within dihydrogen monoxidase environments and sing songs of life "Under da dihydrogen monoxidase", and you want to break our addiction to it as well?

Well sir, I say without some vices, life's just not worth living.

puff! puff! sip!


*cough*


----------



## CFRBryan347768

MSDeltaFlt said:


> If you show up for work and "pee hot", you go home along with your partner who's trying to help you cover it up.  And make sure both of your CV's are up to date while your there.  You should have plenty of time.
> 
> QUOTE]
> 
> So i went back and fourth on this and finally decided to ask does peeing hot mean testing positive for drugs or alcohol?


----------



## Sapphyre

> So i went back and fourth on this and finally decided to ask does peeing hot mean testing positive for drugs or alcohol?



Affirmative, ghostrider.


----------



## mikie

TKO said:


> dihydrogen monoxidase



That was a great scam!

(it's monoxide btw)


----------



## Summit

It always seemed to me that IV NS was only useful for "hangovers" where people are so dehydrated that they couldn't solve it easily PO.

Certainly, people can be "hungover" and not still drunk if they have not taken care of their hydration and nutrition. 

When I was brand new on the ambulance, our medic made me start a line on him for his hangover. I was just excited to get the stick. He told me if I missed, he'd start a 14 on me. I didn't miss.


----------



## tydek07

*Is it the right thing to do? Nope*
Is it done pretty much everywhere? Yes

Pretty much every place I have worked, I have seen pictures/stories of coworkers hooked up to an IV line while drinking ETOH. About the only thing it will let you do, is be able to drink a little longer, as it replaces the water that you would have otherwise lost. I think the hang over will be the same, as you are still losing a lot of liquids while you sleep that fun night off.


----------



## Meursault

Lots of speculation, lots of anecdotes, but nothing definitive.

I'm seeking funding to conduct a prospective study at NCEMSF '09. We need to apply the principles of EBM to this crucial question.


----------



## Jon

ROFLMAO!

Where is it? I'd come to help with the study!


----------



## karaya

I remember way back in my EMT ER clinical days an intoxicated teenager was brought in by ambulance.  Nothing wrong with kid other than the fact he was  drunk.  Standard practice, vitals and an IV.

I guess "cotton mouth" must have gotten to him pretty good, 'cause when I went to check on him later he'd chewed through the IV tubing and was sucking the IV fluid straight out of the bag to quench his thirst!

Takes all kinds.


----------



## EMERG2011

BruceD said:


> I agree, the overuse of this extremely addictive, pervasive drug (some estimates put it at > 95% of the adult population and > 98% of children currently use!) and the horrible side effects it evokes must be brought to the public's attention.  We must not let one more victim fall prey to oxygen's inescapable physical and psychological dependance.  Perhaps if everyone contacted their local politicians we could finally make progress in the war on this lethal chemical.
> 
> QUOTE]
> 
> 
> Dude, you forgot to mention the dangerous derivative of this drug - DHMO (Dihydrogen Monoxide). Its estimated that more than 300 million Americans are addicted to DHMO. What's worse, is that its been found to be in almost every lake, river, and stream in North America. What is truly sad is, in Africa, an addict will walk for hours and hours, just to get enough doses to keep themselves and their children from going into DHMO withdrawal. I've seen people in Washington selling in both its solid and liquid form (street name: "ice") with impunity on the side of the road...


----------



## Av8or007

What is the issue if you start a line on yourself? Saline and iv supplies are otc, do not require an rx. Any member of the public can go to a pharmacy and buy the stuff.

As for whether or not it works, ive never done it. Moderation is the best approach.

Although iv fluids, iv gravol (injectable is otc here under napra), ibuprofen 400 mg and oxygen may work...


----------



## rwik123

Av8or007 said:


> What is the issue if you start a line on yourself? Saline and iv supplies are otc, do not require an rx. Any member of the public can go to a pharmacy and buy the stuff.
> 
> As for whether or not it works, ive never done it. Moderation is the best approach.
> 
> Although iv fluids, iv gravol (injectable is otc here under napra), ibuprofen 400 mg and oxygen may work...



Uhhhh Normal Saline is a prescription med. You cannot get it OTC.


----------



## Aidey

Holy ghost thread! 

Locked, because this thread is 5 years old, this topic has been discussed between now and then, and bumping it was wildly unnecessary.

Edit: He is in Canada, it may be OTC up there. Things like Tylenol 3 are.


----------

