Vertigo is defined as the hallucination of spinning sensation or rotatory movement and is
frequently combined with severe nausea and vomiting. In Taiwan, an average of 3.13 cases per
100 persons suffer from acute vertigo attack per year. And 1 in 3 patients with vertigo will
have recurrent attack within a year. The sensation of disequilibrium and severe nausea and
vomiting urge patients visit emergent department (ED) for help. Therefore, vertigo is one of
the most common complaints in ED.
Vertigo can be divided into central type and peripheral type. Central type vertigo included
life threatening disease like brainstem hemorrhage or infraction. Although peripheral vertigo
is mostly benign, the acute symptoms relief are usually needed. The first line therapy of
acute peripheral vertigo is using antihistamine or benzodiazepine with other anti-emetic
agents. However, these agents usually have side effects of fatigue and lethargy, which will
cause increasing patients' length of stay or elders' risk of falling.
Sodium bicarbonate is widely used in treating hyperkalemia or metabolic acidosis. Its safety
and no side effect have also been proved. There were few reports of using sodium for
treatment of acute vertigo in Taiwan and Japan. However, there is no strong evidence of
comparing this therapy with other medication.
This study hypothesized that there is an equivalence of efficacy between sodium bicarbonate
and diphenhydramine for treatment of vertigo. Using sodium can cause less fatigue or lethargy
and can decrease ED length of stay. This study aims to perform a double-blinded randomized
controlled trial to evaluate the efficacy of sodium bicarbonate for treatment of acute
peripheral vertigo.