High dose intravenous multivitamin therapy in intoxicated individuals
Date First Published:
August 14, 2015
Last Updated:
November 1, 2015
Report by:
Dr. Ivan D'Souza, Specialty Doctor (Wrightington Wigan and Leigh NHS Foundation Trust)
Search checked by:
Dr Ivan D'Souza, Wrightington Wigan and Leigh NHS Foundation Trust
Three-Part Question:
In [severely intoxicated patients with reduced GCS] is the use of [high dose intravenous multivitamins] in [reducing symptoms and overall outcome]
Clinical Scenario:
A 17 year old male found intoxicated on the street brought in by ambulance unconscious. Smelled of ethanol. Alcohol specialist team advised to give high dose multivitamins. Made me wonder if high dose intravenous multivitamin actually improves clinical outcomes in intoxicated patients
Search Strategy:
("ethanol"[All Fields] OR "ethanol"[All Fields] OR "alcohol"[All Fields] OR "alcohols"[All Fields] OR "alcohols"[All Fields]) AND multivitamin[All Fields] AND intravenous[All Fields] AND ("musa"[All Fields] OR "musa"[All Fields] OR "banana"[All Fields]) OR bag[All Fields]
Search Details:
3 studies were found which actually fit the above criteria
2 of them had no abstracts
single study found below compared alternative vitamin therapy for alcohol related illnesses
2 of them had no abstracts
single study found below compared alternative vitamin therapy for alcohol related illnesses
Outcome:
2012 May;59(5):408-12. doi: 10.1016/j.annemergmed.2011.06.021. Epub 2011 Jul 29.
Implementing evidence-based changes in emergency department treatment: alternative vitamin therapy for alcohol-related illnesses.
Implementing evidence-based changes in emergency department treatment: alternative vitamin therapy for alcohol-related illnesses.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Implementing evidence-based changes in emergency department treatment: alternative vitamin therapy for alcohol-related illnesses Faine, B 2012 United states of america | emergency department (ED) patients who present with alcohol-related illnesses | Implementing evidence-based changes in emergency department treatment: alternative vitamin therapy for alcohol-related illnesses | no comparison based on withholding multivitamins | ||
| Vitamin deficiencies in acutely intoxicated patients in the ED. Li SF; Jacob J; Feng J; Kulkarni M 01-Sep-08 USA | OBJECTIVE: Physicians often administer intravenous multivitamins to intoxicated patients in the emergency department (ED); however, this practice is not supported by evidence from any prior study. We determined the prevalences of vitamin deficiencies in patients presenting to our ED with alcohol intoxication. METHODS: This study was a prospective, cross-section, observational study of a convenience sample of ED patients presenting with acute alcohol intoxication. Patients were tested for B(12), folate, and thiamine levels as add-ons to their blood samples. RESULTS: Seventy-seven patients were included in the final analysis. The mean age was 46 years, and 19% were female; the mean blood alcohol level was 280 mg/dL. Of 75 patients, no one (0%) had low B(12) or folate levels (95% confidence interval, 0-0.05); 6 (15%) of 39 patients had low thiamine levels (95% confidence interval, 0.06-0.31). Of these 6 patients, none exhibited clinical signs of thiamine deficiency. CONCLUSIONS: In our ED, patients with acute ethanol intoxication do not have B(12) or folate deficiencies. A significant minority (15%) of patients have thiamine deficiency; its clinical significance is unclear. Widespread administration of multivitamins is unwarranted by these findings, but thiamine may be considered |
Author Commentary:
In the absence of good quality evidence, a prospective randomized trial of therapies for this condition is warranted to determine which therapy is the best
Bottom Line:
Adher to local guidelines and protocol in interim period
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Faine, B. Implementing evidence-based changes in emergency department treatment: alternative vitamin therapy for alcohol-related illnesses
- LoVecchio F. Multivitamin "banana bags" provide little value in emergency department patients
- Li SF; Jacob J; Feng J; Kulkarni M. Vitamin deficiencies in acutely intoxicated patients in the ED.