The throw-up throw-down

The Annals of Emergency Medicine published a study by April et al., that compared inhaled isopropyl alcohol to oral ondansetron for acute nausea. Although this isn't the first time isopropyl aromatherapy for nausea has been assessed; it is the best designed study, and assessed patients over a longer period than had been previously studied. This was a single center randomized, blinded placebo controlled trial that enrolled 122 nauseated adults who didn't require IV access into one of three arms:

1. inhaled isopropyl plus 4mg oral ondanseton 
2. inhaled isopropyl plus oral placebo 
3. inhaled saline plus 4 mg oral ondansetron 

A convenience sample of 208 patients with a presenting chief complaint of nausea or vomiting were screened for inclusion with 122 meeting inclusion/exclusion criteria.

• age > 18years
• presenting complaint of nausea or vomiting with a severity of 3/10 or greater

Exclusion criteria were:

• Isopropyl or ondansetron allergy
• inability to inhale through nose
• recent ingestion of medication contraindicated with alcohol
• altered mental status
• history of prolonged QTc
• suspected or known pregnancy
• patients who had IV access established
• Provider discretion

Reported nausea scores (0-100) were collected from patients at the 0, 10, 20, and 30 minute points. Initial nausea scores were similar across all three treatment arms. The findings noted a significant reduction in need for rescue antiemetic and patient reported nausea within both isopropyl aromatherapy arms; but not in the saline plus ondansetron arm.

This was a well designed study of emergency department patients who presented with a common emergency complaint, the clinical findings are impressive and are significant when considered in association with previous research on the topic. The results of this study alone should be interpreted with caution, however given that it was a single center trial with a small sample size. Additionally there was no discussion of statistical power, the confidence intervals were large and often crossed zero (although this could be due to an under-powered sample size), and that patients were often able to deduce which treatment they had received.

Despite the lack of statistical power this is a study that has the potential to change nursing practice: it suggests that isopropyl aromatherapy may be effective for a prolonged period, that it may show superiority to ondansetron and that it seems to be safe for people with mild to moderate nausea. This is a cheap easily executed therapy, one that doesn't require a prescription, it could be used effectively as a temporizing measure, or as an adjunct to other antiemetics. 


April, M. D., Oliver, J. J., Davis, W. T., Ong, D., Simon, E. M., Ng, P. C., & Hunter, C. J. (2018). Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial. Annals of emergency medicine.