Whiff of doubt: is inhaled isopropyl alcohol (alcohol wipes) an effective treatment for acute nausea in the emergency department?

A short evidence review was conducted to evaluate whether inhaled isopropyl alcohol (IPA) is an effective non-pharmacological treatment for acute nausea in adults presenting to the emergency department (ED). MEDLINE, EMBASE and the Cochrane Library were searched from database inception to the date of search using controlled subject headings and free-text terms. Following screening, six relevant studies were identified, comprising two systematic reviews/meta-analyses, two randomised controlled trials and two implementation studies. Current evidence suggests that inhaled IPA provides rapid short-term relief of acute nausea and may reduce the need for conventional antiemetics. Implementation studies further demonstrate that IPA can be administered rapidly, reduce treatment costs and integrate effectively as a simple, self-directed intervention within ED care pathways. Importantly, no included study evaluated nausea and vomiting of pregnancy or hyperemesis gravidarum, and several studies explicitly excluded pregnant patients. Although inhaled IPA appears to be an inexpensive, readily available and well-tolerated intervention for acute nausea in the ED, its efficacy and safety during pregnancy remain unknown. Well-designed pregnancy-specific randomised controlled trials are required before its use can be recommended in pregnancy.