FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4386585714> ?p ?o ?g. }

• W4386585714 endingPage "5" @default.
• W4386585714 startingPage "5" @default.
• W4386585714 abstract "Figure: banana bag, IV hydration, alcohol use disorder, acute alcohol intoxicationFigureIV hydration clinics are the latest thing, with actual physicians touting this therapy as a way to get hangover relief, build athletic stamina, lose weight, and prevent exhaustion. Apparently, it's such a booming business that even urgent care is getting into it. It's unlikely we are going to start providing this in the ED, but one aspect of IV hydration does need our attention: banana bags. These are given any time a patient who has a history of alcohol use disorder or is acutely intoxicated presents to the ED. They seem harmless, but we should stop using them for many reasons. Banana bags may differ depending on the institution, but most contain a host of parenteral multivitamins mixed in saline or dextrose water, including folate, B12, magnesium, and thiamine. It is difficult to measure if they help patients, but Li, et al., valiantly tried in 2008, finding in a prospective observational study that none of 75 adult patients with acute alcohol intoxication who presented to an urban ED had vitamin B12 or folate levels below the normal range. (Am J Emerg Med. 2008;26[7]:792.) Only six patients had borderline low thiamine levels, with no one exhibiting symptoms. No one had megaloblastic anemia either. This was a small, single-center study, but the results should still raise eyebrows. Thiamine and Wernicke's Another study showed that folate deficiency rates in those with alcohol use disorder do not greatly differ from those of the general population. Only five of 52 patients who had alcohol use disorder had a folate deficiency compared with two of 48 patients in the control group. No statistical difference was seen between the groups, so empiric folate administration was likely unnecessary. (Am J Emerg Med. 1992;10[3]:203.) Thiamine receives the most attention compared with the other vitamins in those with alcohol use disorder because of the dreaded Wernicke's encephalopathy. Many argue it's necessary because Wernicke's is difficult to diagnose and associated with 20 percent mortality if left untreated. (J Neurol Neurosurg Psychiatry. 1986;49[4]:341; https://bityl.co/CmpA.) Naturally, every physician wants to avoid this pathology and empirically give thiamine, and banana bags do contain 100 mg of thiamine. This has traditionally been the recommended daily amount for treating Wernicke's, but this was an arbitrary dose assigned in the 1950s, not based on any scientific research. Current research suggests that higher amounts of thiamine should be given because of the short parenteral half-life. (Ann Emerg Med. 2007;50[6]:715.) Many experts now say at-risk patients should be taking 100 mg twice a day orally. But a banana bag is not going to solve the problem if you are concerned about your patient having Wernicke's. Expensive and Unnecessary You will be shocked at how expensive banana bags are, and the lack of evidence for their effectiveness seals the deal. One retrospective ED study found that educating emergency physicians about unnecessary orders for banana bags for those with alcohol use disorder saved an average of $44,000 annually. (Ann Emerg Med. 2011;58[4 Suppl]:S257.) The cost of a banana bag depends on where you practice and your hospital charges, but many hydration clinics charge anywhere from $150 to $500 per infusion. (https://mobileivmedics.com. Accessed June 20, 2022.) Add on emergency department overhead and staffing costs, and you could be looking at a bill in the thousands. Banana bags are not only an expensive IV fluid, they are also an unnecessary one. Multiple studies have demonstrated that IV fluids alone do not increase ethanol metabolism or change length of stay in the ED. (Emerg Med Australas. 2013;25[6]:527; https://bityl.co/CmpY.) Neither banana bags nor IV fluids should be given to accelerate metabolism to sobriety in acutely intoxicated patients. Oral “rally packs” are totally acceptable for patients who need vitamin supplementation. Most patients do not have difficulty absorbing vitamins in their gastrointestinal tract. Oral multivitamins are understandably much cheaper than banana bags, and they are easier to give and take less time. (J Emerg Med. 1998;16[3]:419.) We should not be surprised that banana bags fall short of delivering any meaningful impact on patient care. We tailor our approach to electrolyte and fluid replacement in each of our patients, and those with alcohol use disorder shouldn't be any different. A one-size-fits-all approach is inappropriate, and we are not helping this vulnerable patient group even though hanging a banana bag makes us feel like we are. Most importantly, take the time to sit down and talk with your patients who misuse alcohol. Discuss their nutritional habits and prescribe thiamine and other multivitamins. Talking to patients about prevention is always more effective than a bag of expensive fluids. Thank you to Tom Benzoni, DO, for this topic suggestion. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected]. Dr. Briggsis an assistant professor of emergency medicine at the University of South Alabama in Mobile. He is the founder, podcast co-host, and editor-in-chief of EM Board Bombs (https://www.emboardbombs.com), a multiplatform educational tool designed to provide board prep and focus on what you need to know for the practice of emergency medicine. Follow him on Twitter@blakebriggsmd." @default.
• W4386585714 created "2023-09-11" @default.
• W4386585714 creator A5026079642 @default.
• W4386585714 date "2022-08-01" @default.
• W4386585714 modified "2023-09-29" @default.
• W4386585714 title "Clinical Controversies" @default.
• W4386585714 doi "https://doi.org/10.1097/01.eem.0000855792.28780.98" @default.
• W4386585714 hasPublicationYear "2022" @default.
• W4386585714 type Work @default.
• W4386585714 citedByCount "0" @default.
• W4386585714 crossrefType "journal-article" @default.
• W4386585714 hasAuthorship W4386585714A5026079642 @default.
• W4386585714 hasConcept C118552586 @default.
• W4386585714 hasConcept C126322002 @default.
• W4386585714 hasConcept C141071460 @default.
• W4386585714 hasConcept C177713679 @default.
• W4386585714 hasConcept C185592680 @default.
• W4386585714 hasConcept C187212893 @default.
• W4386585714 hasConcept C188816634 @default.
• W4386585714 hasConcept C23131810 @default.
• W4386585714 hasConcept C2776203871 @default.
• W4386585714 hasConcept C2776940978 @default.
• W4386585714 hasConcept C2777958118 @default.
• W4386585714 hasConcept C2779750884 @default.
• W4386585714 hasConcept C2781066024 @default.
• W4386585714 hasConcept C3019288012 @default.
• W4386585714 hasConcept C55493867 @default.
• W4386585714 hasConcept C71924100 @default.
• W4386585714 hasConceptScore W4386585714C118552586 @default.
• W4386585714 hasConceptScore W4386585714C126322002 @default.
• W4386585714 hasConceptScore W4386585714C141071460 @default.
• W4386585714 hasConceptScore W4386585714C177713679 @default.
• W4386585714 hasConceptScore W4386585714C185592680 @default.
• W4386585714 hasConceptScore W4386585714C187212893 @default.
• W4386585714 hasConceptScore W4386585714C188816634 @default.
• W4386585714 hasConceptScore W4386585714C23131810 @default.
• W4386585714 hasConceptScore W4386585714C2776203871 @default.
• W4386585714 hasConceptScore W4386585714C2776940978 @default.
• W4386585714 hasConceptScore W4386585714C2777958118 @default.
• W4386585714 hasConceptScore W4386585714C2779750884 @default.
• W4386585714 hasConceptScore W4386585714C2781066024 @default.
• W4386585714 hasConceptScore W4386585714C3019288012 @default.
• W4386585714 hasConceptScore W4386585714C55493867 @default.
• W4386585714 hasConceptScore W4386585714C71924100 @default.
• W4386585714 hasIssue "8" @default.
• W4386585714 hasLocation W43865857141 @default.
• W4386585714 hasOpenAccess W4386585714 @default.
• W4386585714 hasPrimaryLocation W43865857141 @default.
• W4386585714 hasRelatedWork W1767677052 @default.
• W4386585714 hasRelatedWork W2012612785 @default.
• W4386585714 hasRelatedWork W2044830503 @default.
• W4386585714 hasRelatedWork W2053114403 @default.
• W4386585714 hasRelatedWork W2283090002 @default.
• W4386585714 hasRelatedWork W2404277387 @default.
• W4386585714 hasRelatedWork W2437615565 @default.
• W4386585714 hasRelatedWork W2755661196 @default.
• W4386585714 hasRelatedWork W2898916526 @default.
• W4386585714 hasRelatedWork W2340086259 @default.
• W4386585714 hasVolume "44" @default.
• W4386585714 isParatext "false" @default.
• W4386585714 isRetracted "false" @default.
• W4386585714 workType "article" @default.