Intravenous Multivitamin Therapy Use in Hospital or Outpatient Settings: A Review of Clinical Effectiveness and Guidelines [Internet]

Excerpt

Nutritional deficits can lead to side effects such as diarrhea, weight loss, inflammation of the tongue, and anemia, among other symptoms.^, Malabsorption issues (issues absorbing macronutrients and micronutrients from food) can cause nutrient deficits and may be caused by damage to the intestines, (such as damage through gastrointestinal disorders) or through surgery (such as a removal of a portion of the intestine). Examples of other causes of nutrient deficits include major burns (causing hypermetabolism), or acute kidney injury requiring renal replacement therapy. Individuals with nutrient deficits may require additional nutrient supplementation, often in the form of oral supplementation, intravenous (IV) supplementation, or nasogastric supplementation. Nutrient supplementation has also been used in patients with chronic alcohol use disorders or in individuals who are intoxicated. Some IV administered solutions of multivitamins are colloquially termed “banana bags” and may contain a litre of IV fluid infused over 24 hours with a combination of thiamine, folic acid, magnesium, and a multivitamin. Other solutions are colloquially termed “Myer’s cocktails” and may contain vitamin C, B complex, magnesium chloride, calcium gluconate, hydroxocobalamin, pyridoxine hydrochloride, and dexpanthenol.

Micronutrient infusion through IV has increased in popularity, especially among independent complementary and alternative medicine clinics, or in emergency departments, but its efficacy in certain populations, such as in individuals with alcohol use disorders is debated. The purpose of this review is to examine the clinical effectiveness of IV multivitamin therapy in patients that may require nutrient supplementation, who are not on total parenteral nutrition. This is in comparison to either no supplementation, or standard oral supplementation in patients who can orally ingest food. Additionally, the purpose of the review is to examine evidence-based guidelines regarding the use of IV multivitamin therapy.

For the purposes of this report, “IV multivitamin therapy” includes vitamins and other micronutrients, such as minerals, as the classic “Myer’s cocktail” and “banana bags” both contain a mixture of vitamins and minerals.

This report is an upgrade of a previous 2020 CADTH Reference List titled “Intravenous Multivitamin Therapy Use in Hospital or Outpatient Settings: Clinical Effectiveness and Guidelines”; therefore, studies identified in that report were evaluated for potential inclusion in this review.