Nasally inhaled isopropyl alcohol helpful for nauseated ED patients

Last Updated: 2015-12-18

By Shannon Aymes

NEW YORK (Reuters Health) - Nasally inhaled isopropyl alcohol improved nausea compared to placebo in nauseated ED patients, according to a new clinical trial.

"Isopropyl alcohol swabs are cheap, portable, and easy to find," co-author Dr. Antonia Helbling from San Antonio Uniformed Services Health Education Consortium in Texas told Reuters Health by email. "Every EMS unit and nurse's cart is stocked with them to clean skin for IVs and fingersticks. Any member of the care team can use isopropyl alcohol swabs to start making patients feel better without an IV or a prescription."

In a report online December 8 in the Annals of Emergency Medicine, Dr. Helbling and colleagues note that isopropyl alcohol nasal inhalation has been shown to be an inexpensive and effective means to treat postoperative nausea and vomiting.

Although nausea and vomiting is a common complaint in the emergency department (ED), no studies have looked at isopropyl alcohol nasal inhalation as a treatment in the ED.

The researchers conducted a randomized, double-blind, placebo-controlled trial using a convenience sample of adults with nausea or vomiting. Participants were randomly assigned to nasally inhale from a pad of isopropyl alcohol or normal saline at the start, 2 minutes, and 4 minutes for no more than 60 seconds. Rescue antiemetics were offered for participants who had no improvement at 10 minutes. Nausea, pain, and patient satisfaction scores were obtained. Forty-three inhaled saline and 37 inhaled isopropyl alcohol.

Participants in the treatment group had a lower median score on the verbal numeric response scale (VNRS, 0-10) for nausea at 10 minutes compared with patients in the placebo group (3 vs 6, p<0.001).

There were no significant differences in pain scores between the groups, and the percentage of participants receiving rescue antiemetics did not differ.

Patients in the isopropyl alcohol group demonstrated higher satisfaction scores at 10 minutes (4 vs 2 on a scale of 1-5), the researchers report. They caution, however, that study blinding may have been limited by the scent of the isopropyl alcohol pads.

The antinausea effects of isopropyl alcohol are not fully understood. One possible explanation is that they are due to "olfactory distraction", the researchers suggest.

Dr. Robert Meek, director of emergency medicine research at Dandenong Hospital in Melbourne, Australia, who wasn't involved in the trial, told Reuters Health by email, "isopropyl alcohol, inhaled from an impregnated wipe, is something that is easy for a triage/reception nurse to hand out, and which may be helpful without doing harm, for giving some rapid, but probably temporary, reduction in nausea in an ED (or GP) waiting room, while the patient is waiting for a fuller assessment and institution of definitive treatments as required."

The authors report no disclosures.

SOURCE: http://bit.ly/1MlmrEe

Ann Emerg Med 2015.