Article

Intravenous crystalloid fluid for acute alcoholic intoxication prolongs emergency department length of stay

Journal logoUnlabelled imageIntravenous crystalloid fluid for acutea”>American Journal of Emergency Medicine 36 (2018) 2103-2128

Contents lists available at ScienceDirect

American Journal of Emergency Medicine

journal homepage:

Correspondence

Intravenous crystalloid fluid for Acute alcoholic intoxication prolongs emergency department length of stay

To the Editor,

I read with great interest the article entitled “Intravenous crystalloid fluid for acute alcoholic intoxication prolongs emergency department length of stay” by Homma et al. [1]. The authors investi- gated the association between Intravenous crystalloid infusion (IVF) and the length of stay in the emergency department (ED) among patients with acute alcohol intoxication. They concluded that IVF for the treatment of acute alcohol intoxication prolongs the length of stay in the ED. Despite the lack of evidence, alcohol-Intoxicated patients are still routinely treated with IVF [2]. Therefore, this study added important treatment information in this area. Nonetheless, I think there are several issues in this study that should be confirmed.

First, what is the proportion of patients who received a Bolus infusion of crystalloid fluid (e.g., a 1-L bolus of crystalloid fluid) in the IVF group? This article lacks important information regarding how much crystalloid fluid the patients received and how rapidly the patients were infused with crystalloid fluid in the IVF group. Without this information, it is difficult to discriminate the effectiveness of a bolus infusion of crystalloid fluid from the effect of the placement of venous access. Second, was there a difference between the two groups regarding Blood pressure and heart rate at admission in the ED? Because dehydration is an important indication for IVF [3], patients with tachycardia and hypotension are more likely to be treated with IVF. Thus, the difference between the two groups in the proportion of dehydration might confound the outcome. Third, did the authors evaluate the Recovery time utilizing the full score of the Glasgow coma scale (GCS)? If the GCS score was monitored in their routine care, this assessment could be performed. Evaluation of other outcomes, such as gait and GCS score, would augment the authors’ conclusion that IVF for the treatment of acute alcohol intoxication was not useful if the recovery time to the full score of the GCS did not differ between the IVF and no IVF groups. Given that many factors such as ED crowding, testing, and consultation affect the ED length of stay [4,5], an additional evaluation of other related outcomes is important in the observational study design.

As the authors noted, it is unclear why IVF significantly prolonged

the length of stay in the ED by approximately 60 min. Given that this study is not a randomized controlled design but a retrospective observa- tional design, the authors should minimize the confounding factors af- fecting the outcome as much as possible and interpret their findings cautiously.

Junpei Komagamine MD Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi 3208580,

Japan E-mail address: [email protected].

1 February 2018

https://doi.org/10.1016/j.ajem.2018.03.019

References

  1. Homma Y, Takashi S, Hoshina Y, Numata K, Mizobe M, Nakashima Y, et al. Intravenous crystalloid fluid for acute alcoholic intoxication prolongs emergency department length of stay. Am J Emerg Med 2017. https://doi.org/10.1016/j.ajem.2017.12.054.
  2. Perez SR, Keijzers G, Steele M, Byrnes J, Scuffham PA. Intravenous 0.9% sodium chlo- ride therapy does not reduce length of stay Alcohol-intoxicated patients in the emer- gency department: a randomised controlled trial. Emerg Med Australas 2013;25: 527-34. https://doi.org/10.1111/1742-6723.12151.
  3. Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorate G, et al. Acute alco-

    hol intoxication. Eur J Intern Med 2008;19:561-7 (doi: 10.1016/j.ejim.2007.06.033).

    McCarthy ML, Zeger SL, Ding R, Levin SR, Desmond JS, Lee J, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high- acuity patients. Ann Emerg Med 2009;54:492-503. https://doi.org/10.1016/j. annemergmed.2009.03.006.

  4. Casalino E, Wargon, Peroziello A, Choquet C, Leroy C, Beaune S, et al. Predictive factors for longer length of stay in an emergency department: a prospective multicentre study evaluating the impact age, patient’s clinical acuity and complexity, and Care pathways. Emerg Med J 2014;31:361-8. https://doi.org/10.1136/emermed-2012- 202155.

    Effect of High-carbohydrate meals on the rate of ethanol metabolism on emergency department patients

    Over 4% of all emergency department visits are secondary to acute or chronic alcohol intoxication [1]. Clinicians may observe these patients for extended periods of time in the emergency department (ED). Often they are admitted for observation because they have no caregiver available. There are many influences as to the rate of detoxification of patients, one of which is the consumption of food. It has been shown that consumption of alcoholic beverages along with or just after eating diminishes the intensity and duration of intoxication. It has also been noted that a faster rate of ethanol elimination was seen when its pas- sage through the liver was slower and more prolonged, which is the case when alcohol is consumed during or after a meal [2]. The objective of this study was to determine if simply feeding intoxicated ED patients a meal might increase the metabolism of ethanol, allowing for faster hospital disposition.

    We conducted a prospective clinical study using a convenience sam- ple of patients admitted to the ED with acute alcohol intoxication. The study took place at a single urban U.S. academic medical center over a

    0735-6757/(C) 2018

Leave a Reply

Your email address will not be published. Required fields are marked *