We humans have put a man on the moon, created robotic vacuums and realistic filters on Snapchat but have’t solved the age-old problem of alcohol hangovers ! While no consensus exists on the mechanism, most think it’s a combination of : aldehyde accumulation, dehydration from peeing away water, vitamins & minerals, low glucose, lack of good sleep and direct toxic-inflammatory effect of alcohol in various degrees (acute alcoholic gastritis for example).
Hangovers can be overlooked in patients admitted early or pre-withdrawals (example a voluntary check-in by a intoxicated alcoholic, or an inebriated, obtunded person brought in by the cops, etc.). Since symptoms & signs between hangover & withdrawals can overlap and can do a seamless transition, only dumping Lorazepam (Ativan) doses for any ‘withdrawal’ symptoms could keep the hangover simmering for longer. Plus, hangovers can last more than 24 hours in some people.
So just like we have a CIWA-Score for Alcohol Withdrawal assessment, I remember another CIWA-S to recall measures to hangover symptom mitigation & preventing higher severity. This seeks to counter most of the postulated hangover causes mentioned in the first paragraph:
C – Carb-loading. If nauseous or intoxicated, add Dextrose-containing IV fluids ( remember that some banana bags may be NS based, switch to D5-NS based). Good practice to do Thiamine with or before carb-loading.
I – Inflammation suppression : low-dose scheduled NSAIDs if not absolutely contraindicated. Read why Tylenol not advised or only in low doses.
W – Water & Electrolytes & Vitamins : Gatorade-style drinks or Dextrose-Banana bags mentioned earlier
A – Antacid & Antiemetic meds : IV Protonix + PO Maalox initially for rapid acid-suppression for gastritis ( especially if using NSAIDs ). For nausea, I prefer Metoclopramide (Reglan) or Prochlorperazine (Compazine) instead of Zofran since headaches are common
S – Sleep-Aids: (unless heavily intoxicated / sleepy anyway). I like low schedule doses of Libirum with caution & PRN-basis only in severe hepatitis or cirrhosis.
PS: I wanna emphasize this isn’t a CURE for hangover, rather steps to help curtail the intensity & duration of a hangover misery.
