• Medical Saline: A Versatile Intravenous Fluid
• The Controversy Around Vitamin IV Drips
• Towards Responsible Use: Best Practices for Clinicians
• Conclusion

The intravenous administration of saline solutions and nutrient infusions has become an increasingly common practice in both mainstream and alternative medicine. However, controversy remains regarding the purported health benefits of vitamin-enriched IV drips and their appropriate clinical applications. As the founder of the Iv Drip Clinic in London, I have seen an upsurge in public interest around IV therapy. In this comprehensive 3000 word article, I aim to provide physicians with a practical overview of medical saline, critically evaluate the evidence for vitamin IV drips, and offer best practice guidelines for integrating these treatments into patient care plans.

Medical Saline: A Versatile Intravenous Fluid

Saline is one of the most ubiquitous and versatile fluids used in medicine today. It consists of sodium chloride dissolved in sterile water at a concentration that matches blood plasma. The two most prevalent formulations are:

• Normal saline – 0.9% sodium chloride, considered isotonic with human blood. This is the standard fluid used for IV infusion.
• Lactated Ringer’s solution – Contains sodium, potassium, calcium, chloride, and lactate ions. Often used to replenish electrolytes.

Thanks to its safety and compatibility, saline has a wide range of clinical applications including:

Rehydration and Fluid Resuscitation

Saline is ideal for reversing or preventing dehydration and restoring vascular volume in hypovolemic shock. It quickly replenishes both the water and electrolytes lost through vomiting, diarrhea, blood loss, burns, or excessive sweating. It is absorbed rapidly from the bloodstream into the tissues. Compared to drinks like sports beverages, IV saline provides faster, more complete rehydration.

During surgery, repeated boluses of normal saline are used to replace blood loss and maintain hemodynamic stability. Saline is preferred over lactated Ringer’s in trauma settings, where it minimizes acidosis.

Cleansing and Irrigating Wounds

Saline irrigation is a mainstay for cleansing traumatic wounds, burns, and skin ulcers. The solution helps remove debris, exudate, and contaminants while maintaining a moist environment optimal for healing. Saline soaks also draw out purulent material from infected wounds. Plastic surgeons use saline injection to hydrate tissues prior to closure.

Delivering IV Medications and Contrast Dyes

Given its neutral pH and tonicity, normal saline serves as an ideal solvent and delivery medium for many intravenous drugs, particularly when rapid infusion is required. It ensures drugs like anesthetics, antiemetics, antidotes, and fluids like blood products remain stable and compatible once injected.

Saline is also used as a flushing medium before and after injecting contrast dyes for angiograms, CT scans, and other radiologic studies. This prevents adverse reactions between contrast agents.

Catheter Patency and Blood Drawing

Small flushes of saline keep intravenous and arterial lines patent between infusions. This reduces the risk of blood clots occluding the catheters. Applying positive saline pressure facilitates drawing blood samples quickly and efficiently from central and arterial lines.

Wound Care and Skin Integrity

Besides wound cleansing, saline wet-to-dry dressings help debride necrotic wounds and enhance granulation. Saline soaks soften hard eschars on burns to aid their removal. In stasis ulcers, saline dressings maintain moisture while absorbing exudate.

For patients with fragile skin, applying gauze soaked in saline protects against damage that may be caused by adhesives. Saline gel dressings like Hydrogel provide moisture to spare tissues with impaired perfusion.

Other Uses

Some additional applications of intravenous saline include:

• Rinsing contact lenses to remove irritants
• Instilling as eye drops to relieve dry eyes
• Delivering in a nebulizer for relief of upper airway obstruction
• Bladder irrigation to dissolve clots following resection surgery
• Cervical injection to soften and dilate the cervix during labor
• Joint injection to distend spaces before imaging studies
• Predilution solution for renal dialysis treatments

In emergency scenarios, normal saline in standard IV bags can also serve as makeshift ice packs to induce therapeutic hypothermia following cardiac arrest or stroke.

Overall, normal saline and lactated Ringer’s provide an isotonic crystalloid base that is used to administer medications, replace fluid losses, and maintain general electrolyte homeostasis.

Side Effects and Contraindications

For most patients, saline is extremely safe even when given in large volumes. However, certain side effects can occur:

• Hypervolemia – Excess saline may lead to pulmonary edema or peripheral edema if administered too rapidly, especially in kidney impairment.
• Hypernatremia – High sodium levels can develop in patients with severe renal insufficiency or sodium wasting disorders.
• Acidosis – Large volumes infused quickly may lower blood pH, requiring buffering.
• Hypocalcaemia – Replacing extracellular calcium lost when saline is excreted in urine.
• Rebound diuresis and electrolyte depletion – IV saline leads to excretion of more urine and electrolytes.

Patients with heart failure, kidney failure, or severe sodium imbalance may require lower saline volumes or more frequent lab monitoring when receiving IV therapy. Otherwise, saline has minimal contraindications for short-term use.

The Controversy Around Vitamin IV Drips

In contrast to saline, vitamin-enriched IV drips occupy a much greyer area of clinical practice. Formulations containing high doses of vitamins, glutathione, amino acids, and antioxidants are promoted to correct deficiencies, detoxify the body, enhance wellness, and extend healthspan.

Despite celebrity endorsements and bold marketing claims, evidence supporting the benefits of many IV nutrition cocktails remains quite limited. Clinicians are rightly concerned about profit-driven clinics administering unproven treatments with little physician oversight.

To help separate fact from fiction, I will examine some of the most popular formulations and the existing data behind their purported benefits:

High Dose Vitamin C

Vitamin C is an essential nutrient with well-documented antioxidant properties. Oral supplementation is proven to speed recovery from illness and improve iron absorption. Proponents of high dose IV vitamin C claim it can:

• Shorten the duration of colds and flu
• Accelerate wound healing after surgery or burns
• Reduce cancer growth and increase survival when combined with chemotherapy
• Improve quality of life for terminal cancer patients

Clinical evidence overall does not clearly support these claims. While IV vitamin C is well-tolerated, any benefits seen in preliminary studies may simply result from correcting pre-existing deficiencies in sicker patients. There is no proof of additional benefits above accepted oral doses for healthy individuals.

B Complex Vitamins

Thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid and cobalamin are water soluble vitamins with synergistic roles in energy metabolism. Many seek B complex IV drips hoping to increase energy, sharpen mental clarity, improve mood, and reduce stress. However, robust clinical evidence supporting these effects is lacking, especially in subjects without deficiencies. While generally safe, B complex IVs may carry risks like anaphylaxis or nerve damage from very high doses. Patients with normal B vitamin levels are unlikely to benefit.

Glutathione

Glutathione is an endogenous antioxidant involved in multiple biosynthetic pathways. IV glutathione is advertised to replenish reserves depleted by chronic illnesses like HIV or hepatitis. It is also promoted to lighten skin tone. While animal models and some human studies show possible benefits for Parkinson’s disease, male infertility, and fatigue, current clinical applications are still considered experimental. Caution is needed as toxicity has occurred at higher doses.

Myers Cocktail

Developed in the 1970s, the Myers cocktail contains magnesium, calcium, B vitamins, vitamin C and often other additions like glutathione. Advocates claim it can treat chronic fatigue, fibromyalgia, depression, and acute asthma. However, robust studies verifying these subjective benefits are lacking. Risks include electrolyte disturbances and fluid overload. Given the limited evidence, Myers cocktail IVs should be avoided outside research settings.

Amino Acids

Certain IV amino acid solutions may help restore nutrition in illness or after surgery. Otherwise, healthy individuals obtain adequate amounts from dietary protein intake. As precursors for neurotransmitters, some formulations are advertised to improve mood disorders when absorbed directly into the bloodstream. However, mood benefits have not been shown clinically. Unnecessary amino acid infusions increase the risk of phlebitis and metabolic disturbances.

Anti-Aging and Wellness Drips

Private IV clinics market a variety of “wellness” or “anti-aging” vitamin cocktails claiming to slow aging, optimize health, and prevent disease. These infusions represent an expensive form of “insurance” against deterioration for affluent clients without clear medical need. While individual ingredients may provide symptomatic relief in deficiency states, no evidence suggests they extend lifespan or confer dramatic benefits in well-nourished individuals.

Athletic Performance Enhancement

Certain B vitamins and amino acids are required cofactors in energy metabolism. Athletes including MMA fighters and cyclists have taken to IV drips before competitions hoping to maximize energy, endurance, and recovery. The few placebo-controlled trials conducted show minor subjective benefits on performance at best. Given the lack of regulation around IV clinics, athletes also risk inadvertent doping violations from tainted products.

Hangover Recovery

IV clinics market biweekly “hangover drips” containing saline, vitamins, and anti-emetics for partygoers to reverse alcohol’s effects. While IV fluids can help rehydrate and settle the stomach, regular use may enable risky drinking habits. Potential risks include infections, blood clots, or masking underlying conditions. Overall, evidence does not support using routine IVs for hangover relief.

This analysis reveals that while individual nutrients may offer targeted benefits in proven deficiencies, data supporting benefits of most IV vitamin cocktails is lacking. Judicious use based on clinical rationale and testing is advised.

Towards Responsible Use: Best Practices for Clinicians

How then should licensed clinicians approach requests for IV vitamin therapy while upholding rigorous standards? Here are some suggested best practices:

• Conduct a thorough evaluation– Take time to fully understand the patient’s medical, social, and psychological situation. Probe their motivation for seeking IV therapy. Identify any deficiencies or diagnoses that may justify treatment. Screen for kidney/cardiac issues.
• Check baseline laboratory studies– Order tests like complete blood count, electrolytes, vitamin levels, and liver enzymes. These provide objective data to guide planning.
• Provide counseling on oral supplementation– For mild deficiencies without malabsorption, oral vitamins and diet modifications may suffice. IVs should not replace addressing lifestyle factors.
• Follow accepted clinical indications– The strongest evidence supports IV vitamin C for burns and post-op recovery, B vitamins for fatigue in renal failure, etc. Stay within established dosing ranges.
• Avoid unproven combinations– Myers cocktails, hangover drips, and other mixtures lack strong clinical justification. Favor single ingredient drips where possible.
• Use responsible advertising– Claims that downplay risks or make excessive promises can mislead patients. Be realistic when discussing expected benefits.
• Obtain proper patient consent– Disclose the limitations around evidence, risks like phlebitis, potential for drug interactions, and alternatives.
• Adhere to sterile IV technique– Uphold proper standards for needle handling, bottle penetration, mixing, site cleaning, disposables, and documentation.
• Monitor patients during and after– Watch for fluid overload symptoms or anaphylaxis. Follow-up afterwards to assess subjective benefit and adjust course as needed.
• Report complications– Track infections, adverse reactions, side effects. Report to regulators to improve overall safety.

With conscientious precautions, IV vitamin infusions can be incorporated into care plans for specific indications where benefits outweigh the risks. However, responsible clinicians must also acknowledge their limitations to avoid overpromising.

Conclusion

In closing, medical saline remains a versatile fluid with proven utility across many clinical scenarios. In contrast, vitamin IV drips are an emerging practice still seeking an adequate evidence base. While they may offer targeted benefits in certain deficiencies, routine use in well-nourished individuals remains difficult to justify. As physicians, we must apply judicious reason and uphold ethical standards, rather than embracing infusion therapy as a lucrative fad. With further research clarifying appropriate applications, IV nutrient therapy can become another safe, effective arrow in our quiver. But for now, we must remain clear-eyed about realistic benefits versus hype.

References

• Agostoni C, Marangoni F, Riva E, Giovannini M, Galli C, Risé P, Galli C, Riva E, Colombo C, Marangoni F, Giovannini M. Plasma arachidonic acid and serum thromboxane B2 concentrations in healthy infants, children and adults. Pediatr Res. 1996 Aug;40(2):264-7. doi: 10.1203/00006450-199608000-00017. PMID: 8807659.
• Jahanban-Esfahlan A, Mehrzadi S, Reiter RJ, Seidi K, Majidinia M, Baghbani E, Yousefi B, Sadeghpour Tabaei S, Labibi F, Ebrahimi L. Melatonin in regulation of inflammatory pathways in rheumatoid arthritis and osteoarthritis: Involvement of circadian clock genes. Br J Pharmacol. 2019 Aug;176(15):2703-2715. doi: 10.1111/bph.14695. Epub 2019 Jun 10. PMID: 30953647; PMCID: PMC6613972.
• Kashiouris MG, L’Heureux M, Cable CA, Fisher BJ, Leichtle SW, Fowler AA. The Emerging Role of Vitamin C as a Treatment for Sepsis. Nutrients. 2020 Feb 22;12(2):292. doi: 10.3390/nu12020292. PMID: 32098229; PMCID: PMC7071252.
• Mousavi, S.M., Bereswill, S. and Heimesaat, M.M. (2019), Immunomodulatory and Antimicrobial Effects of Vitamin C. Microbiology and Molecular Biology Reviews, 83: e00045-18.https://doi.org/10.1128/MMBR.00045-18
• NIH. (2020, September). Vitamin C. Retrieved fromhttps://ods.od.nih.gov/factsheets/VitaminC-Consumer/
• Patanwala AE, Edwards TS, Rahmdal MG, Ernst ME. Evaluating High-Dose Vitamin C as a Potential Non-Traditional Therapy in Burn Intensive Care Units: A Review of the Literature. J Pharm Pract. 2021 Dec;34(6):1178-1182. doi: 10.1177/08971900211011826. Epub 2021 Jan 27. PMID: 33503113.
• Shirvani, A., Kalajian, T.A., Song, A. et al. Disseminated Intravascular Coagulation With the Use of Intravenous Vitamin C in Critically Ill Patients: A Retrospective Review of Cases. Clin Appl Thromb Hemost 26, 1076029620948786 (2020).https://doi.org/10.1177/1076029620948786