# Thiamine and the "Coma cocktail"



## pumper12fireman (Sep 15, 2008)

How many of your services carry thiamine?? None of the services I work for do, but the "coma cocktail" (narcan, thiamine, D50) has also been taken out of our protocols. For those of you that do carry it, how often do you use it??


----------



## Cross924 (Sep 15, 2008)

*Thiamine*

We carry thiamine on our trucks.  We only have protocols for its use in cases of hypoglycemia that might show relation to possible malnutrition or b1 depletion due to chronic alcohol abuse.  In cases of hypoglycemia we give it to boost glycogen production before we administer d50.  In cases of alcohol abuse we have standing orders for 100 mg just to replenish the b1 supply.  This is a gray area for us because we are not a very " pro-active agency".  We should probably use it more than we do.  Kinda happens when your entire ALS roster for your agency consists of two intermediates and one enhanced.


----------



## bstone (Sep 15, 2008)

An an Intermediate, I am allowed to use it in cases of delerium tremens. 100mg IV push.


----------



## KEVD18 (Sep 15, 2008)

i generally try to practice more evidence based medicine. the spaghetti method of medicine has never really appealed to me.


----------



## Flight-LP (Sep 15, 2008)

As we attempt to evolve more, it has become painfully evident that generic universal type treatments are not appropriate. Thiamine is nice to have, especially in the case of malnourishment, D50 is a no brainer for hypoglycemia and can also be used for hyperkalemia. Narcan in my mind is worthless and only used to piss patients off. Other than Paramedic induced OD (i.e. can't perform simple medical math), there really is no other use for it..........


----------



## grumpy1 (Sep 16, 2008)

My state protocols are simple; IVP with D50 in cases of hypoglycemia.


----------



## mycrofft (Sep 16, 2008)

*Hello, I worked detox for six years in a locked facility...*

DT's are addressed with something to quiet down the CNS without depressing respiration (not barbiturates) or potentiate the possible oncoming seizures (that rules out Thorazine, and Compazine). Ativan and Valium worked for us (Ativan for quickness, and Valium for smooth long effect...but we gave them orallty whenever possible). We followed with a month of multivits and B1.

Narcan and Compazine have other unwanted side effects. If the pt is in first trimester, Compazine can be teratogenetic. If the pt is high on opiods and pregnant, sudden detox can often cause fetal death (we taper them down on methadone). Since the pt may not know if she is pregnant, Tigan is used for nausea/vomiting. Don't know what a B1 blast would do to a fetus. Sounds like a rich thread to open, fetal EMS.


----------



## EMT-P633 (Sep 16, 2008)

For the state of TN where i work, it is mandated that all services carry it, our protocals for it are quite simple. to be given in conjunction with D50 for the treatment of suspected malnutrition, and or treatment for severe alcoholics suffering a hypoglycemic episode.


----------



## Ridryder911 (Sep 17, 2008)

The reason for Thiamine w/D50w is the potential Wernicke encephalopathy, due to lack of Vitamin B1 deficiency. Because of the potential, Thiamine help prevent this if Dextrose has to administered. 

We removed Thiamine from our list due to the low number of incidences, as well that we attempt to give a lower concentration level.

R/r911


----------



## bonedog (Sep 19, 2008)

mycrofft said:


> We followed with a month of multivits and B1.



Excellent point, thiamine deficiency and associated Wernicke's/Korsakoffs takes extended tx for reversal.

The study from which the thiamine/dextrose tx was derived was in the forties and had a low number of patients.(something like 4)

Another one of those urban medical myths me thinks....


----------



## Ridryder911 (Sep 19, 2008)

Actually Wernickes is very real but not as popular as once thought of. The bad side (as I read for the post here) is that it is not very treatable if it does occur and can have long term side effects. 

Something to consider....


----------



## bonedog (Sep 19, 2008)

Too true Rid, like looking at the scan's of chronic alcholics, pretty hard to fill in those holes.


----------



## Grady_emt (Sep 20, 2008)

Our "Clinical Care Guidelines" have Thiamine in the Following:

Hypoglycemia:  Pts getting D50 also get 100mg Thiamine slow IVP

AMS: pts with ETOH onboard get a Mix Bag consisting of a 1000ml bag, 100mg thaimine, 25g Dextrose, 2g Mag Sulfate


----------

