High dose intravenous multivitamin therapy in intoxicated individuals

Report By: Dr. Ivan D'Souza - Specialty Doctor
Search checked by Dr Ivan D'Souza - Speciality doctor
Institution: Wrightington Wigan and Leigh NHS Foundation Trust
Original author: Dr Ivan D'Souza
Original institution: Wrightington, Wigan and Leigh NHS Foundation Trust
Current web editor: Simon Carley - Consultant in Emergency Medicine
Date Submitted: 14th August 2015
Last Modified: 1st November 2015
Status: Blue (submitted but not checked)

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]
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

Search 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.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

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

Editor Comment

Recommend a randomised control trial to study the benefits of intravenous multivitamin infusions in patients coming to emergency department with alcohol related problems

Clinical 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 Annals of Emergency medicine Ann Emerg Med. 2012 May;59(5):408-12. doi: 10.1016/j.annemergmed.2011.06.021. Epub 2011 Jul 29.
LoVecchio F Multivitamin "banana bags" provide little value in emergency department patients Ann Emerg Med. 2012 May;59(5):414-5. doi: 10.1016/j.annemergmed.2011.11.007
Li SF; Jacob J; Feng J; Kulkarni M Vitamin deficiencies in acutely intoxicated patients in the ED. American Journal of Emergency Medicine 01 September 2008, vol./is. 26/7(792-795), 07356757