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Background Acute alcohol intoxication is a common condition observed in the emergency department (ED). Intravenous fluid therapy (IVF) is often administered to treat this condition, but its effectiveness remains unclear. We therefore conducted a study to evaluate the effect of IVF on length of time from arrival at the ED until awakening, which is a novel and more appropriate variable. Methods This single-center, prospective observational study was conducted in the ED of Self-Defense Forces Central Hospital, a secondary emergency hospital in Tokyo from October 1, 2018 to July 31, 2019. Patients were assigned to groups to receive either a 1,000-mL bolus of lactated Ringer’s solution or only cannulation. The primary outcome was length of until awakening. Secondary outcomes were length of stay in the ED and the occurrence of conditions requiring extra care. Univariate and multivariate regression analyses were performed. Predictors of the occurrence of any event that required extra care were identified using a statistical model. Results The final sample included 201 patients: 109 received IVF and 92 did not. There was no significant difference in baseline characteristics between the groups. Median length of time until awakening was 211 min (interquartile range [IQR], 119 min) in the IVF group and 208 min (IQR, 149 min) in the non-IVF group (p = 0.77). Multivariate regression analysis demonstrated that the regression coefficient of IVF for length of time until awakening was − 9.55 (95% confidence interval [CI], \(-\)36.2 to 17.2). However, hemoglobin (regression coefficient, \(10.1\); 95% CI, \(0.38\)-19.9) and initial Glasgow Coma Scale score (GCS) in the ED (regression coefficient, \(-\)7.51; 95% CI, \(-\)10.8 to \(-\)4.21) were significantly associated with length of time. Conclusions This is the first study to evaluate the effect of IVF therapy on the length of time until awakening. IVF therapy is not effective in shortening the length of time in patients with acute alcohol intoxication in the ED. Routine administration of IVF is unnecessary in these patients. Further research is warranted to investigate who benefit from IVF therapy. A significance difference in Hb and GCS in this study also would give useful tips for the next study.

ObjectiveGout, caused by hyperuricaemia, is a multifactorial disease. Although genome-wide association studies (GWASs) of gout have been reported, they included self-reported gout cases in which clinical information was insufficient. Therefore, the relationship between genetic variation and clinical subtypes of gout remains unclear. Here, we first performed a GWAS of clinically defined gout cases only.MethodsA GWAS was conducted with 945 patients with clinically defined gout and 1213 controls in a Japanese male population, followed by replication study of 1048 clinically defined cases and 1334 controls.ResultsFive gout susceptibility loci were identified at the genome-wide significance level (p−8), which contained well-known urate transporter genes (ABCG2 and SLC2A9) and additional genes: rs1260326 (p=1.9×10−12; OR=1.36) of GCKR (a gene for glucose and lipid metabolism), rs2188380 (p=1.6×10−23; OR=1.75) of MYL2-CUX2 (genes associated with cholesterol and diabetes mellitus) and rs4073582 (p=6.4×10−9; OR=1.66) of CNIH-2 (a gene for regulation of glutamate signalling). The latter two are identified as novel gout loci. Furthermore, among the identified single-nucleotide polymorphisms (SNPs), we demonstrated that the SNPs of ABCG2 and SLC2A9 were differentially associated with types of gout and clinical parameters underlying specific subtypes (renal underexcretion type and renal overload type). The effect of the risk allele of each SNP on clinical parameters showed significant linear relationships with the ratio of the case–control ORs for two distinct types of gout (r=0.96 [p=4.8×10−4] for urate clearance and r=0.96 [p=5.0×10−4] for urinary urate excretion).ConclusionsOur findings provide clues to better understand the pathogenesis of gout and will be useful for development of companion diagnostics.