4 A total of 77 patients, with a mean age of 46 years and mean blood alcohol level of 280 mg/dL, were included in their analysis. In a recent evaluation by Li and colleagues, investigators evaluated serum folate, thiamine, and vitamin B12 levels in acutely intoxicated patients with a detectable blood alcohol level and clinical evidence of intoxication. Non-alcoholic individuals typically take four to five months to develop megaloblastic anemia with low dietary folate intake this timeline can be shortened to five to ten weeks in alcoholics. 3 Ethanol abuse causes rapid declines in folate stores (within 2-3 days) and eventually leads to the development of megaloblastic anemia. Folic acidĮthanol inhibits the absorption of folate and impairs its enterohepatic cycle. Obviously if patients show signs of dehydration, IV fluids are a reasonable intervention. 2 The bottom line from his literature review: there’s no evidence that IV fluids expedite sobriety in patients with acute alcohol intoxication.

The majority of his review focused on a recent trial that found no difference in ED length of stay, treatment times, or breath alcohol levels at 2 hours with the administration of IV fluids (compared to no IV fluids). He discussed four papers that evaluated ethanol clearance with IV fluid administration. Salim Rezaie did some recent mythbusting on REBEL EM regarding the utility of IV fluids for intoxicated patients 1. But it seems the combination of these components may be unnecessary, let’s break it down piece by piece: 1.

Furthermore, the administration of fluids is conventionally believed to help speed up sobriety. The rationale behind ordering banana bags for these patients is relatively simple–alcoholics are likely to have nutritional deficiencies related to their dietary preferences for alcohol over nutrient-dense foods, putting them at risk for complications. Banana bags are commonly utilized in patients at risk for alcohol withdrawal symptoms or those who present to the emergency department (ED) acutely intoxicated. We’re all pretty familiar with the banana bag: intravenous (IV) fluids with the addition of thiamine, folic acid, multivitamins, and sometimes magnesium.

Give thiamine before glucose