Wake Up And Smell the Isopropyl

Why? It’s just as good or better than the sweet, sweet taste of ondansetron dissolving under your tongue.

This is a rather small, but quite interesting trial, building upon prior work evaluating the use of inhaled isopropyl alcohol for nausea. It’s better than saline placebo, yes, but what about those actual doctor-type medicines we use so can bill as a Level 3 or Level 4 visit?

This three-arm trial randomized 40 patients each into inhaled isopropyl + ondansetron oral dissolving tablet, inhaled isopropyl + oral placebo, and inhaled placebo + ondansetron oral dissolving tablet. Even despite the limitations of sample size with regard to statistical significance, the isopropyl arms are the clear winners with regard to their primary outcome of nausea score reduction at 30 minutes. Objective outcome measures were mixed – receipt of rescue antiemetics mirrored the primary outcome, but measures of ED length-of-stay and admission disposition could not demonstrate a difference.

Some fun tidbits here – patients were allowed to have an unlimited supply of alcohol medication pads to use throughout their ED stay, not just on initial arrival. They did not quantify how many pads were utilized by patients included in these arms. The authors also evaluated the effectiveness of blinding on their study, and, as expected, found it’s hard to miss the distinctive scent of isopropyl alcohol – and this introduces a potential source of bias to these results.

Overall, at least, it certainly seems reasonable to use isopropyl alcohol pads as adjunctive therapy for nausea in the ED – and as an inexpensive, over-the-counter option for patients (well, and doctors) at home.

“Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial”
https://www.ncbi.nlm.nih.gov/pubmed/29463461