Alcohol to inpatients??!!!

[joaquin13]

I have just discovered something new. A lot of hospitals will actually give alcohol to patients who are alcoholics in the hospital and have no desire to quit! I couldn't believe it. You can choose wine, beer, or hard alcohol for your patients (depending on what they usually drink) and the AMOUNT they usually drink (ie my patient the other day got 6 beers with dinner) and even the brand they like.

Anyone else ever hear of this? I am at the beginning of my 4th year, and had absolutely no idea!!!

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[Boomer]

How do I get admitted to this hospital? And, where is it????

 

[Mirror Form]

oh yeah, if you do a rotation in a VA hospital you'll find that about 1/3 your patients are getting beer brought to them in bed.

 

[SoulRFlare]

I just heard a story about a guy who came into the ER after ingesting ethylene glycol. The doc prescribed a vodka drip. (it was Popovs)

 

[gwyn779]

Yup, I've seen it ordered. Of course, the psych people I was rotating with at the time went nuts about how people were too lazy to put alcoholics on a benzo taper. Even if people don't want to quit, it hardly seems like we should be encouraging them to continue by providing them with alcohol.

And yes, you treat etylene glycol or methanol ingestion with ethanol. 🙂

 

[MD'05]

Up until a few years ago, the hospital staff (where I rotate) kept the airline-sized bottles of alcohol for the patients to use as DT prophylaxis. They now use the Ativan protocol; I believe the switch was made because the staff, students, and doctors were drinking up all the alcohol

 

[Gauss]

I just heard a story about a guy who came into the ER after ingesting ethylene glycol. The doc prescribed a vodka drip. (it was Popovs)

Vodka drip???? LOL
But as already stated the treatment for ethylene glycol poisoning is EtOH

To avoid alcohol withdrawal some places use alcohol. Considering Lorazepam is generic and doesn't affect the liver I fail to understand this logic.
And taper?? pffft, if they're edgy increase it, if they're stuporous lower it.

 

[MustafaMond]

Ethanol drip has been used for a long time as DT prophylaxis.
I have seen mainly surgeons using it.
On medicine, we use ativan protocol.
I give beer to my elderly DNR patients, who drink everyday. There is no point to detox them in the hospital, if they have no willingness to quit.

 

[ERMudPhud]

I like the nursing home patients who come in with a copy of their med sheet that says something like Bourbon 2 shots Qhs

 

[Jaded Soul]

I've also seen EtOH drip for DT prophylaxis in the surgical ICU. I've never seen orders allowing patients to drink alcohol, though.

 

[TommyGunn04]

Yup, it's true, the VA computer system allows you to order alcohol for your patients. The funny thing is, it shows up on the order sheet as "beer liquid."

 

[kchan99]

Vodka drip for ethylene glycol poisoning? Was it a leftover from a staff party? I would be worried about contaminants.

At psych emerg in a Calif hospital, it was lorazepam for withdrawal. Was "beer liquid" ordered only when the pt refused benzos? I'm curious--what brand was the "beer liquid"? How was it dispensed to the pt, as in can or by cup? Did the pharmacy make a point of keeping it cold?
😕

 

[southerndoc]

I've ordered alcohol to my patients before (as a med student).

The theory is that when they are in there after suffering a serious injury, now is not the time to try to detox them and run the risk of seizures, hypertension, etc.

Think about it... 20 years of alcoholism. Why must you detox them during their 2-week stay in the hospital? We also get a psych consult and have the patient arranged to have outpatient followup (or voluntary inpatient admission when their medical/surgical issues have resolved).

 

[b&ierstiefel]

Wow! What a concept. Makes sense...detox is kind of a lifestyle change in the end. Here they give patients benzos, I haven't happened to see EtOH orders.

 

[Yosh]

I have done ETOH protocol...and benzo regimin...but NEVER got to order alcohol....That is really interesting....

 

[double elle]

Have a guy who had surgery on Thursday. Chronic alcoholic. He will only be in the hospital 3 days and has NO desire to quit drinking. We wrote orders for beer....he wasn't drinking any and was starting to get shakey. We asked why he wasn't drinking any beer. He sheepishly grinned that he preferred whiskey. So, the order for beer was CD'd and a new order was written for whiskey - 1 shot every couple of hours as needed for tremors. They guy got the little bitty bottles and just poured it in his sprite.

It's not a surgeon's job to detox anyone. I mean, what if someone came into the hospital due to a trauma or something - you detoxed him....and he has complications despite the medical management of DT's....he did NOT give you permission to detox him. Can he sue?

Why put yourself on the line. He isn't there for his alcoholism..he's there for another procedure/illness. When you withhold the alcohol, you risk other health problems that YOU are now responsible for, because he is admitted under YOUR name.

It's wacky - but it happens at our hospital pretty frequently.

 

[kchan99]

I guess dispensing EtOH beverages prevents the situation with pt's family or friends bringing in the drinks. When the drinks are dispensed officially, there is a way of knowing how much EtOH the pt has been using. One time, I saw a hospital inpatient on the same bus I was riding. He got on at the stop in front of a convenience store where he bought something (I don't know what.) I realized he was wearing a hospital gown under his robe. He got off the bus at the hospital stop and just got on an elevator. He didn't look like a visitor at all.

 

[Yosh]

I agree that it makes sense...I just think it is wild....

 

[Carbon]

We do it all the time, even as part of admission orders. Like last night, for the guy who claimed >1 pint vodka qd.

 

[Winged Scapula]

Have a guy who had surgery on Thursday. Chronic alcoholic. He will only be in the hospital 3 days and has NO desire to quit drinking. We wrote orders for beer....he wasn't drinking any and was starting to get shakey. We asked why he wasn't drinking any beer. He sheepishly grinned that he preferred whiskey. So, the order for beer was CD'd and a new order was written for whiskey - 1 shot every couple of hours as needed for tremors. They guy got the little bitty bottles and just poured it in his sprite.

It's not a surgeon's job to detox anyone. I mean, what if someone came into the hospital due to a trauma or something - you detoxed him....and he has complications despite the medical management of DT's....he did NOT give you permission to detox him. Can he sue?

Why put yourself on the line. He isn't there for his alcoholism..he's there for another procedure/illness. When you withhold the alcohol, you risk other health problems that YOU are now responsible for, because he is admitted under YOUR name.

It's wacky - but it happens at our hospital pretty frequently.

I've had the same experience on several occasions. Just last week I was seeing a patient on the Neurosurgery service as a trauma surgery consult and noticed that she was prescribed 1 beer PO QID prn. I then noted that she had failed to ingest any and was displaying some classic signs of DTs. When I reminded her that since she had no desire to quit drinking and that she could have a beer up to 4 times a day, she replied that she preferred whisky. Which is what I of course suggested in my consultation note! 😉

 

[DeLaughterDO]

Have also seen beer ordered with each meal for men who have had urological surgeries (TURP, etc) to increase UOP. Nothing like walking into your patient's room to eggs, roll and miller lite!

jd

 

[starayamoskva]

Even with a benzo taper there is no absolute guarantee that the person won't experience DT's which can be fatal. So why not give them "the hair of the dog."
Our hospital pharmacy is not allowed to keep the beer cold (supposedly to keep the staff out of it).
When I worked as a nurse we had a bottle of bourbon in our lock up box that we had to count along with the narcotics every shift and almost always had some patient that got a shot or two every night.