Hangover cure

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http://www.foxnews.com/health/2012/04/09/hangover-heaven-offers-mobile-cure-in-las-vegas/

This is brilliant, but I'm not sure about the legality of it.

Hangover Heaven is a curbside service designed to treat people with hangovers by rehydrating them with IVs and giving them anti-nausea medicine.

Started by Dr. Jason Burke, a board-certified anesthesiologist who graduated from Duke University, the company offers various packages and will ‘deliver’ them to you; their fleet of has pickup areas at major Las Vegas hotels.
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I think every doc has talked about doing something like this. This guys actually did it. Doesnt seem like he's really giving you much more than Normal Saline, Zofran, and toradol...although the website states it's a 'proprieterial' mix.

I'm sure most of the participants are ASA 1's and maybe 2's.

The guy is a genius.
 
periopdoc said:
It's all fun and games until somebody gets a raging phlebitis.

-pod
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true...I wonder what his consent says... I'm sure it's a full disclosure and releases him of all liability.

Plus, according to the website, he's using either a 22G or 24G....so......

my concerns would be more of giving IVF to patients w/ CHF/renal failure patients. But I'm sure they screen for that before giving it.
 
PinchandBurn said:
true...I wonder what his consent says... I'm sure it's a full disclosure and releases him of all liability.

Plus, according to the website, he's using either a 22G or 24G....so......

my concerns would be more of giving IVF to patients w/ CHF/renal failure patients. But I'm sure they screen for that before giving it.
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Are his patients even consentable? I'm assuming their BAC is still elevated +/- MDMA, nose candy, etc.
 
PinchandBurn said:
true...I wonder what his consent says... I'm sure it's a full disclosure and releases him of all liability.

Plus, according to the website, he's using either a 22G or 24G....so......

my concerns would be more of giving IVF to patients w/ CHF/renal failure patients. But I'm sure they screen for that before giving it.
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I looked at the website and didn't see mention of a 22G or 24G. One of the plans specifies "two bags of IV fluids" and that it takes "approximately 45 minutes". Even with a pressure bag or power infuser, can you put 1 liter or 2 liters through a 22 or 24 in 45 minutes? (I say 1 or 2 liters, because I can picture this businessman having 500mL bags instead of liters - or maybe it's a total scam and he's going with 250's!).

OK, I gave them a call. Very nice chick on the phone. She said a 22, and they use a pediatric tubing set, a pressure infuser, and it is 2 liters. I said that the only thing that matters is catheter diameter and length, but she said that the doc told her that they could do it.

It's a great gig if you can get it! However, I told her about the old paramedic days (and, God's honest truth, I NEVER did this), where, on Sunday mornings, there would be two medics holding up each other's bags of saline, and that such was "really pathetic" (my words), but that the real key was an amp of D50. That brought the victims to life.
 
Apollyon said:
I said that the only thing that matters is catheter diameter and length, but she said that the doc told her that they could do it.
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Wait- this whole time I thought diameter was the only thing that mattered. I guess it's OK if she said you could still do it.
 
Bertelman said:
Wait- this whole time I thought diameter was the only thing that mattered. I guess it's OK if she said you could still do it.
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She was very honest and very pleasant. She told me she had only been a street EMT-Intermediate. She said that Dr. Burke told her it would work. He's a Duke anes guy - whaddaya say? I mean, it's not like he's some rad onc or path guy.
 
A couple of fried eggs does it for me.
 
PinchandBurn said:
I think every doc has talked about doing something like this. This guys actually did it. Doesnt seem like he's really giving you much more than Normal Saline, Zofran, and toradol...although the website states it's a 'proprieterial' mix.

I'm sure most of the participants are ASA 1's and maybe 2's.

The guy is a genius.
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Agree 100%. I've discussed this idea a million times...glad to see someone execute it. I don't think you could make it profitable anywhere except Vegas.

I personally don't think the IVF does much for you except make you hypothermic.
 
Apollyon said:
You should try it. It works. The dehydration being resolved fixes a LOT.
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Oh, it totally works. HA symptoms are thought to be from the dehydration.

And I'd like to know more about this hypothermia in an awake patient getting 2L infused over 2 hrs. I'd bet it is insignificant, if it's even detectable.
 
On my college EMS squad, we had a couple of guys who would prophylactically start IVs before a night of drinking. Why wait to treat a hangover after it happens? Aside from the obnoxiousness of dragging around an IV pole, that is...
 
WholeLottaGame7 said:
On my college EMS squad, we had a couple of guys who would prophylactically start IVs before a night of drinking. Why wait to treat a hangover after it happens? Aside from the obnoxiousness of dragging around an IV pole, that is...
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That's what saline locks, and good friends, are for.
 
WholeLottaGame7 said:
On my college EMS squad, we had a couple of guys who would prophylactically start IVs before a night of drinking. Why wait to treat a hangover after it happens? Aside from the obnoxiousness of dragging around an IV pole, that is...
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In anesthesia, one would draw suspicion quickly if he was seen with a PIV. :eyebrow:
 
Bertelman said:
Oh, it totally works. HA symptoms are thought to be from the dehydration.
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Really? Then why is the headache responsive to both NSAIDs and breakfast burritos?

Bertelman said:
And I'd like to know more about this hypothermia in an awake patient getting 2L infused over 2 hrs. I'd bet it is insignificant, if it's even detectable.
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That, um, "anecdotal" experience was based on a 2L infusion taking place in a span of time considerably shorter than 2h 😀
 
"Research on human subjects analyzing blood and urine samples determined biological correlates that may explain the pathology of alcohol hangover. These analyses showed that concentrations of various hormones, electrolytes, free fatty acids, triglycerides, lactate, ketone bodies, cortisol, and glucose were not significantly correlated with reported alcohol hangover severity. Also, markers of dehydration (e.g., vasopressin) were not significantly related to hangover severity. Some studies report a significant correlation between blood acetaldehyde concentration and hangover severity, but most convincing is the significant relationship between immune factors and hangover severity. The latter is supported by studies showing that hangover severity may be reduced by inhibitors of prostaglandin synthesis. Several factors do not cause alcohol hangover but can aggravate its severity. These include sleep deprivation, smoking, congeners, health status, genetics and individual differences. Future studies should more rigorously study these factors as well as biological correlates to further elucidate the pathology of alcohol hangover."

http://www.ncbi.nlm.nih.gov/pubmed/20712596
 
fakin' the funk said:
That, um, "anecdotal" experience was based on a 2L infusion taking place in a span of time considerably shorter than 2h 😀
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Unless you measured your core temp (rectal probe?), I suspect you may have been using shivering/subjective feelings as a surrogate in this "patient". Every day I am in the OR I feel cold, but I doubt I'm hypothermic. Of course, I haven't checked my core temp recently, either.

I imagine if you push that fluid fast enough you could induce hypothermia, but your (patient's) body has a remarkable ability to maintain normothermia in the absence of anesthetics.
 
dhb said:
"Research on human subjects analyzing blood and urine samples determined biological correlates that may explain the pathology of alcohol hangover. These analyses showed that concentrations of various hormones, electrolytes, free fatty acids, triglycerides, lactate, ketone bodies, cortisol, and glucose were not significantly correlated with reported alcohol hangover severity. Also, markers of dehydration (e.g., vasopressin) were not significantly related to hangover severity. Some studies report a significant correlation between blood acetaldehyde concentration and hangover severity, but most convincing is the significant relationship between immune factors and hangover severity. The latter is supported by studies showing that hangover severity may be reduced by inhibitors of prostaglandin synthesis. Several factors do not cause alcohol hangover but can aggravate its severity. These include sleep deprivation, smoking, congeners, health status, genetics and individual differences. Future studies should more rigorously study these factors as well as biological correlates to further elucidate the pathology of alcohol hangover."

http://www.ncbi.nlm.nih.gov/pubmed/20712596
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so the doc claims to have something that 'flushes out acetaldehyde'. Other than fluids, I wonder what else is in the 'secret concoction"😀
 
Bertelman said:
Unless you measured your core temp (rectal probe?), I suspect you may have been using shivering/subjective feelings as a surrogate in this "patient". Every day I am in the OR I feel cold, but I doubt I'm hypothermic. Of course, I haven't checked my core temp recently, either.

I imagine if you push that fluid fast enough you could induce hypothermia, but your (patient's) body has a remarkable ability to maintain normothermia in the absence of anesthetics.
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I've thoroughly forgotten undergrad physics/transport phenomena but I don't think 2L (~2kg) at 20C would significantly change the core temp of someone who weighs 70kg or more at 37C after equilibration.
 
This study involved intentionally inducing hypothermia for neuro pts. Using much lower temps (1-6 C), higher density fluid, and much faster infusion rates (albeit lower volumes), they only lowered temp less than a degree C.

Anesth Analg 1999;89:163–9

Moderate hypothermia is often used for cerebral protection during anesthesia for cerebral aneurysm clipping. No reliable, rapid, and practical noncardiopulmonary bypass methods for the induction of hypothermia to core temperatures ,34°C have been reported. We assessed the effects of IV administration of chilled 5% albumin (5 mL/kg at 1– 6°C) on core temperature after surface cooling to approximately 34°C. We calculated thermal distribution volume from the change in core temperature after the chilled fluid infusions. We also compared rapid administration (5 mL/kg over 30 min) with very rapid administration (5 mL/kg over 3–5 min). Chilled albumin 5 mL/kg infused over 5 min reduced core temperature by 0.6 +/- 0.1°C. The same volume of chilled albumin infused over 30 min reduced core temperature by 0.4 +/- 0.1°C. The calculated thermal distribution volume was less than one third of total body volume. Because the thermal distribution volume in these hypothermic patients was much lower than total body volume, the chilled IV fluids in this study were 3 times more effective in inducing hypothermia than suggested by a simple calculation. To achieve maximal effectiveness, however, chilled fluids must be administered very rapidly (.100 mL/min) to avoid heat gains in standard IV tubing that occur even with rapid administration. Implications: Chilled IV fluids can be much more effective for the induction of hypothermia than commonly assumed, but they must be administered very rapidly to avoid heat gains in IV tubing.
 
Last edited:
from same study:
heat deficit = volume of fluid administered * density of fluid administered * heat capacity of fluid administered * (initial temp - tem of fluid administered)
 
PinchandBurn said:
so the doc claims to have something that 'flushes out acetaldehyde'. Other than fluids, I wonder what else is in the 'secret concoction"😀
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I hope Colonel Sanders was consulted on this concoction as well...
 
pgg said:
Only if you want to make the hangover worse, I'd think, since 90% of a hangover is dehydration. 🙂
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Not if you adequetly hydrate the patient. Think about it aldehydes are water soluble if you increase urine output theoretically you could be removing the aldehydes. I thought the aldehydes were fed into the tca cycle.
 
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