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]

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]

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]

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]

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]

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.