Nausea is a common complaint seen in the Emergency Department (ED). Although there are a number of agents available for treatment, the efficacy and safety of these drugs have recently come into question. Metoclopramide is a commonly used antiemetic agent but it carries significant side effects including akathesia and tardive dyskinesia. Ondansetron is another central acting drug that has been shown to be effective in nausea prophylaxis in patients receiving chemotherapy but has a black box warning due to its effect of prolonging the QT interval. Additionally, a recent RDCT in the Annals of Emergency Medicine demonstrated a lack of benefit in terms of nausea relief of metoclopramide or ondansetron in comparison to placebo (Egerton-Warburton 2014)
Isopropyl alcohol is not a common antiemetic in the ED but has been used extensively as an effect agent in the post-operative setting. Whether its effectiveness is isolate to post-anesthetic administration or not is unknown.
Does nasally inhaled isopropyl alcohol reduce nausea in ED patients.
All persons18 – 65 yo who presented with a chief complaint of nausea
or vomiting at a level of > 3 on a 10 point scale.
Nasal inhalation of isopropyl alcohol from a commercially available
Nasal inhalation of normal saline from a commercially available sterile
Primary: Nausea and pain 10 minutes post-intervention
Secondary: Satisfaction score at 1 minutes post-intervention
Randomized, double-blind, placebo-controlled trial drawn from a convenience sample of patients.
Recent anti-emetic use, use of a psychoactive drug or concomitant use of a medication that produces nausea when exposed to alchol (i.e. disulfiram).
- 84 patients screened for the study + 80 agreed to participate (95.2%)
- Isopropyl alcohol n = 37
- Normal saline n = 43
- Baseline characteristics were equal between groups except that the normal saline group had a slightly lower initial pain score.
- Average nausea score at 10 minutes
- Isopropyl alcohol group: 3
- Normal saline group: 6
- Effect size: 3 (CI 2-4)
- No difference in pain score
- Median satisfaction score at 10 minutes
- Isopropyl alcohol: 4
- Normal saline: 2
- Patient-centered primary endpoint
- Randomized trial
- Efforts made to blind both the investigators and the participants
- Intervention is simple, inexpensive and non-invasive
- Convenience sample which may result in selection bias
- Participants were likely unblinded since isopropyl alcohol has a distinct odor
- Researchers may have been unblinded if they were able to smell the pads
- No long-term outcomes available (primary outcome only assessed at 10 minutes post-administration)
- The study is too small to comment on safety
- Does not compare the intervention to standard practice
“We found that nasally inhaled isopropyl alcohol achieves increased nausea relief compared with placebo during a 10-minute period.”
In this small ED study, isopropyl alcohol significantly reduced nausea in patients presenting with nausea and/or vomiting at 10 minutes.
Potential Impact To Current Practice
Patients presenting with nausea or vomiting to the ED could rapidly be treated with isopropyl alcohol swabs during triage to help rapidly alleviate symptoms.
Nasal isopropyl alcohol inhalation can rapidly be administered to patients presenting with nausea or vomiting and has the potential to decrease patient symptomology and suffering. This intervention is cheap and non-invasive. Although this study is too small to show safety, a small dose of inhaled isopropyl alcohol is unlikely to have any significant side effects.
St. Emlyn’s: JC: Can Alcohol Relieve Nausea?
Egerton-Warburton D et al. Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron vs. metoclopramide and placebo. Ann Emerg Med 2014; 64(5):526-532. PMID: 24818542