Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial

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Article Citation: Beadle KL et al. Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med 2016. 68:1-9.e1.

Clinical Question: In non-pregnant adults, is the use of nasally inhaled isopropyl alcohol useful in decreasing nausea?

Bottom-Line Recommendation: The use of nasally inhaled isopropyl alcohol increases nausea relief. Major Points: The effects of isopropyl alcohol (IA) inhalation has been studied and associated with nausea relief in postoperative settings with minimal safety concerns. Antiemetic medication use to treat nausea has not shown superiority to placebo, making isopropyl alcohol a potentially effective treatment for general nausea. Further investigation on the use of IA would benefit patients presenting with nausea/vomiting to the emergency department.

With 80 participants in the randomized control trial, patients were randomly administered inhaled isopropyl alcohol versus inhaled normal saline solution. Nausea, pain, and satisfaction were measured with various verbal, numerical scales with the primary outcome of nausea reduction after 10 minutes of starting. The result of the trial concluded that isopropyl alcohol had statistically significant nausea reduction scores versus placebo in favor of IA after 10 minutes poststart, but and better satisfaction scores versus placebo as well. Pain measurement scores were not significantly significant between the two arms of the study.

While the following study has limitations, it shows positive functions for isopropyl alcohol as an inexpensive option to treat nausea in an ED setting.

Guidelines:

As of July 2016, no guidelines have been published to reflect the results of this trial.

Study Design: Randomized, double-blind, placebo-controlled trial Population (inclusion, exclusion, baseline demographics): Adult patients presenting to an urban tertiary care Emergency Department. Inclusion Criteria: Signs of active vomiting or discomfort Adults (age 18 to 65 years) Chief complaint of nausea or vomiting at a level 3 or greater on a verbal response scale Exclusion Criteria: Known allergy to isopropyl alcohol Inability to inhale through the nares (including recent respiratory tract infection) Inability to read or write in english Altered mental status Receipt of an antiemetic within 24 hours Receipt of a medication known to cause nausea when exposed to alcohol Receipt of a psychoactive medication

Intervention(s): The study intervention comprised of the subject nasally inhaling from a commercially prepared medical preparation pad. These pads were either saturated with isopropyl alcohol or normal saline solution. Both sets of pads were maintained in their original packaging, which was identical except for the label which was covered by brown tape to ensure blinding. Each tape piece had a randomized identification number ranging from 1 to 80 for each patient. The randomization was generated and assigned by a computer system. Investigator blinding was maintained by instructing the patients to open the pad on their own, and if they were physically unable to do so the investigator was instructed to open the pad at an arm’s length to not detect the smell of the alcohol or saline. The patients were instructed to inhale from their specific pad at study start, 2 minute, and 4 minutes. At each of these inhalations, the patients were instructed to inhale deeply for no more than a minute in length, with the pad approximately 2.5cm from their nares. If the patients were to experience nausea relief, they were told to stop continuing with the remaining inhalations.

Outcomes (Primary, Secondary, subgroup, adverse events): Of the 80 participating patients, 37 patients received the isopropyl alcohol and 43 received the normal saline. The primary outcome of this study is that patients who received the isopropyl alcohol (median score= 3) reported lower verbal numeric nausea scores when compared to those receiving the normal saline (median score= 6) (95% CI: 2 to 4). In regard to secondary outcomes, there was no significant difference in pain verbal numeric scores (95% CI: -1 to 2). Subjects who had received the isopropyl alcohol instead of the saline had also reported higher satisfaction scores (Isopropyl Alcohol score average of 4 vs. Normal Saline Solution score average of 2) (95% CI: 2 to 2). There were no serious adverse events reported in any of the patients studied.

Criticisms: Due to this study being based on a convenience sample, selection bias could be a concern when appraising the results. In addition, blinding investigators and patients to the scent of the isopropyl alcohol and saline cannot be guaranteed to have been effective. This study was also limited by the fact that the results are subjectively based off of the patients’ reactions to the isopropyl alcohol versus the saline, and each specific patient’s ability to report their results.

Funding: None identified by the authors. Journal featured a conflict of interest disclosure statement only.