Clinical Science

Case Studies

Intramuscular Wellness And Intravenous Hydration & Nutrient Therapy

Background

 

Intravenous (IV) therapy can trace its origins to the middle-ages when the first experiments were conducted on animals with blood transfusions. Without contemporary knowledge of physiology, these experiments almost always resulted in grave morbidity and were consequently banned by the church. Advances in the field of science as a result of conflicts and epidemics in the subsequent centuries eventually, in the 1800s, gave birth to the rudimentary roots of what is today known as IV therapy.

When first developed, IV drips were reserved only for those that were severely ill. Subsequent improvement in technology and manufacturing techniques made it possible for these life-saving s to be offered in common medical practice. Modern day IV nutrient and hydration therapy has only been used in mainstream medicine for about 50 years. The relative ease of administration and effectiveness versus alternative oral therapy makes this the clinical gold standard in resuscitation and supplementation. Until recently, therapies as such were always dictated by medical professionals and administered in a clinical setting. IVs are becoming increasing popular for patients to receive them as elective for wellness and health maintenance.

In the discussion of intravenous hydration and nutrient therapy, better summed up as IV wellness therapy, it is important to highlight a common misnomer which refers to the s as vitamin drips. Most common day intravenous wellness drips consist of a cocktail of electrolytes, vitamins, anti-oxidants, minerals, amnio-acids, and various miscellaneous supplements.

As in any novel practice, there is considerable debate in the medical community that focuses on two main points, necessity as well as efficacy of these alternative s. Skeptics often overstate the risks involved and overlook the ever-growing amount of literature supporting the benefits.

 

Intravenous Hydration

 

The common denominator with all IV wellness therapy is hydration. This is logical since the human body is composed of predominantly water. Even mild dehydration can result in significant symptomology and disrupt the optimal function of the human body. Various published statistics suggest that dehydration in the general public is a prevalent condition, specially affecting the elderly, chronically ill, with reported figures as high as 98% in certain populations such as elite athletes (24). Dehydration is related to several of the leading causes of death published by the World Health Organization. Epidemiological studies have suggested correlation between chronic dehydration and several common conditions (25).

Hydration is the mechanism that the body uses to dilute and minimize the effect of various offending agents such as allergens, toxins, poisons, free-radicals… It is not a coincidence that IV hydration and nutrient therapy is part of the regimen for almost every person presenting in a clinical setting. The therapy is efficacious at reversing the cause and enhancing recovery from various ailments and is beneficial in several common conditions that are often treated suboptimally with over the counter remedies (26).

This can be clearly delineated in the following case descriptions:

Case Study – Strenuous Activity

A healthy amateur athlete has been exercising in the heat for 4 hrs. During this time, he has had minimal fluid intake. During exercise, the athlete loses electrolytes and water via sweat. At the same time, intensive and repetitive exercise results in mild muscle breakdown and lactic acid buildup with resultant decreased threshold for muscle cramping. Muscle breakdown causes release of free radicals and toxin production which can injure the kidney as well as other body organs. Mild temperature increases during exercise also results in suboptimal functioning of the body and resultant fatigue and weakness.

IV hydration with fluids and nutrients help replenish body water and correct electrolytes. The ratio of serum BUN/CR, a measure of physiologic hydration, can be measured during this process: The ratio is predictive of injury (in this case, dehydration) when BUN/Cr ratio exceeds 20.
Serum electrolytes for NA/CL/K also fluctuate during this process and, as an example, goes from 148/115/4.8 to 135/102/4.0 representing a restoration of equilibrium for optimal bodily function. 
Lactic acid is generated through metabolism with prolonged activity and can cause muscle cramps and impair performance. Body lactic acid can be measured and goes from 3.1 to 1.2 mmol/L, indicating the elimination of Lactic acid, minimizing recuperation time and allowing maximum productivity.

Muscle breakdown from activity results in the generation of toxins and free radicals and in combination with dehydration and heat can result in body tissue and organ impairment and damage. The by products of muscle metabolism can be measured in serum CK and goes from 240 to 125 mcg/L, demonstrating clear elimination of byproducts of muscle metabolism. During this time, mild kidney impairment can also be demonstrated in serum CR rise. After hydration CR improves back to normal from 25/1.3 to 15/1.0 which indicates the body goes from a dehydrated to a hydrated state. (For the adult male, the normal range of creatinine is 0.6 to 1.2 mg/dl, and the normal range of urea nitrogen in blood or serum is 5 to 20 mg/dl)

In summary heat, dehydration and strenuous activity disrupts body equilibrium and generates byproducts that leads to sense of fatigue and can be clearly measured. These are all easily reversible resulting in restoration of bodily norms and maximizing productivity.

Case Study – Mild Viral Syndrome

A middle aged female presents with few day history of generalized weakness, body aches, sore throat, runny nose, nasal congestion and poor appetite. She has several co-workers with similar symptoms. This is a common presentation for someone with typical viral syndrome. The syndrome consists of symptoms that are the result of the release of inflammatory compounds as part of the body’s natural response to combat infectious processes. The symptoms are frequently exacerbated by mild dehydration that occurs due to decreased oral intake from lack of appetite and increased fluid loss as the body fights off the offending process.

Fluids are the mainstay in for the majority of viral infections. The body usually will fight off the infections and the symptoms usually self-limited. Unfortunately, most people experiencing viral illnesses typically have a decreased desire to consume anything by mouth. This dehydration can be evident in the presence of urine ketones as well as increased urine specific gravity. After IV fluids, urine SG goes from 1.035 to 1.010, and urine ketones from 2+ to none detected.

The benefits of hydration can also be measured by the decrease of serum lactate levels from 2.4 to 1.6 mmol/L, which indicates improved hydration status. Serum lactate is elevated in an environment when there is inadequate oxygen delivery to tissues as is commonly the case with dehydration.

During inflammatory process, serum ESR and CRP are also commonly elevated because of their relative ease at which to be measured. These are surrogate markers for serum inflammation, and are just two of the many substances in a group that are commonly known as ‘acute phase reactants’. With the introduction of anti-inflammatory medications and IV hydrations, serum ESR decreases from 28 to 12 mm/hr and CRP, 1.8 to 1.1mg/L.

Viral syndromes are common processes that are usually self-limited but can cause significant discomfort. The constitutional symptoms are a result from dehydration and body inflammatory process. Unfortunately this process also causes people to have decreased desire for oral intake, resulting in delay in elimination of the disease. IV hydration in conjunction with anti-inflammatory medications flushes out toxins and decrease systemic inflammation. The end result is a marked reduction in symptoms severity and shorter recovery time.

Case Study – Seasonal Allergy

A young woman with history of pollen allergies has been having a hard time coping with springtime flower blooming and the subsequent high levels of pollen in the atmosphere in the community where she lives. She typically has the same symptoms yearly and causes her significant distress and decreased productivity due to her physical discomfort. She experiences incessant nasal congestion, sinus aches, dry cough, occasional wheezing and occasional rash. These are the end effects when the body encounters allergens. The body reacts to foreign challenges in many ways but usually with some type of inflammatory process. In the case of allergens, the inflammation includes release of histamine compounds.
Histamine and inflammatory molecule release has various effects on the body and results in the myriad of symptoms experienced. In the nose, it causes blood vessels to become leaky and results in runny nose and nasal congestion. In the lungs, these same compounds cause smooth muscle spasms which cause people to experience wheezing.  On the skin, this process can manifest as a rash, all of which can be extremely disconcerting.

IV fluids and anti-inflammatories/anti-histamines with smooth muscle relaxers are effective at reducing the severity of these symptoms. The fluids help dilute and flush out the offending allergens, and the medications help abate the release of inflammatory compounds and minimize the effects they have on their target organs.

Steroidal anti-inflammatory medications have been proven to stabilize mast cell, a type of cell that coordinates the process of allergic reactions. This stabilization prevents and diminishes the release of inflammatory compounds.

Magnesium is an essential electrolyte but also a medication with smooth muscle relaxing properties. In combination with the anti-histamines, Magnesium helps reduce airway spasm and minimizes wheezing and improves respiratory function.

Seasonal allergy is a common ailment that is benign yet can cause significant discomfort and loss of productivity. IV hydration, dilutes the offending allergen and in combination with medications, decreases the effects of histamines to help alleviate symptoms.

Case Study – Sunburn And Dehydration

A young man spends 6 hours surfing in the hot sun in Hawaii. After a long day, the patient experiences significant sunburn and pain. The radiation energy from the sun’s rays damages the body by causing the release of free radicals which destroy tissues and cells and can result in pain, semi-permanent skin discoloration, dehydration and skin wrinkling.

During sunburn, the energy of the sun triggers an inflammatory process in the skin. This inflammatory process is what accounts for the pain, redness, blistering. During the same time, evaporation and sweat, which are exaggerated from the dermal insult, result in dehydration, which can give the skin a wrinkled appearance.
Non-specific inflammatory mediators such as ESR, CRP are all elevated. IV hydration helps flush out toxins, and dilute the inflammatory mediators, decreasing their interaction with specific proteins that continue the cellular damage. ESR and CRP decrease from 15 mm/hr and 1.8 mg/L to 5 mm/hr and 0.3 mg/L respectively. This decrease in inflammation results in less skin irritation with a subsequent decrease in peeling, blistering and pain.

A decrease in serum CK and lactic acid can also be observed demonstrating the elimination of toxic byproducts from dehydration and inflammation.

Similar to the dehydration process in extreme exercise, the electrolyte disturbance from sunburns is also quickly corrected with intravenous fluids as seen with normalization of NA/CL/K concentrations.

In summary, sunburns are common and frequently accompanied by dehydration. Results usually range from mild short term pain and unsightly skin peeling to longer term scarring and wrinkles . IV hydration with vitamins/anti-inflammatories and anti-oxidants help flush out many of the toxins and helps reduce the pain and unsightly skin distortion.

Intravenous Versus Oral Supplementation

The argument against necessity of intramuscular/intravenous supplementation in favor of oral replenishment is not valid as there are many conditions such as viral syndrome, gastrointestinal diseases, etc. in which oral intake is not desired or subject to high barrier for systemic absorption.

In a healthy subject, orally ingested material traverses through the gastrointestinal tract where it is subject to various harsh environments of acid and digestive enzymes designed to breakdown the ingested product into the building blocks. This exact process makes it not feasible to absorb certain supplements with oral intake.

After exposure to the elements of the gastrointestinal tract, the partially digested material needs to then be absorbed via the intestines, so that in can enter the blood stream. Various factors and health states can significantly alter this absorption barrier, which can significantly diminish the efficacy of oral supplementation.

Finally, once absorbed into the system, the nutrients are siphoned through the liver in a process termed first pass metabolism, during which the liver further breaks down the nutrients into small constituents. The end result is that even in an optimal health state, only a fraction of orally ingested product is delivered to the target organs or tissues. Conversely, IM/IV administration delivers 100% of the ingredients directly into the system.

There is a tremendous amount of anecdotal evidence revealing the dramatic improvement of the way people feel after intravenous/intramuscular supplementation. Ultimately elective intravenous hydration and nutrient supplementation simply provides a superior alternative to oral intake.

IV Wellness – Nutrient & Hydration

There are many types of intravenous wellness s that are being offered to clients. Most common day formulations are a derivative of the Myer’s cocktail.

The Myer’s cocktail was developed and named after Dr. John Myers and describes a mixture of an intravenous solution containing electrolytes such as magnesium and calcium in addition to B and C vitamins with purported uses for relief of chronic pain and fatigue, muscle spasms, upper respiratory infections, seasonal allergies along with a host of other conditions. Clinical data are sparse because of the technical difficulty in creating suitable clinical trials. Nonetheless, another study on patients suffering from chronic pain and fatigue syndrome demonstrated a significant reduction of symptoms with improved energy levels and decreased pain and improved emotional state (4,5,6). Periodic regimented administration has been shown to decrease fibromyalgia symptoms vs placebo in one case series (7,8). There are other applications of intravenous nutrient therapy as aforementioned and numerous case studies with anecdotal evidence that support its benefits.

Several considerations need to be addressed in the formulation and preparation of IV s. To appreciate the complexity of this topic, one must understand the dynamic of fluid and electrolyte physiology. The human body is constantly maintained at a delicate balance and particular salt concentration. When introducing any IV fluids into the system, careful calculations must be undertaken to ensure that the administered solution inclusive of all the ingredients is of a relatively similar electrolyte concentration to the body to maintain equilibrium.

Combining various ingredients in a solution, or the preparation of an admixture, also must be handled correctly to ensure sterility of the resultant . In addition, the different constituents can interact with each other and can result in binding and diminished efficacy of the ingredients. More importantly, if incompatible, this mixing can potentially result in the formation of a precipitate in the solution, which can act as a plug if infused into the system. Therefore, it is absolutely critical that all s be prepared following a traceable protocol and independently tested for contamination and impurities.

Vitamins & Minerals

Vitamin and mineral deficiency, like dehydration, is a prevalent condition that often goes unrealized (27,28,29). Studies have shown that 10-40% of the general public is deficient in B12 for example (34). Certain population groups such as vegan, vegetarians are prone to such deficiency due diet. Others that suffer from gastro-intestinal ailments or the chronically ill, alcoholics, the elderly, and even people that have undergone gastric surgery are also frequently deficient of B12.

Vitamins are compounds that help the body function and participate in various regulatory activities that are essential to life. There are two categories of vitamins, water-soluble vitamins such as B and C vitamins, and fat-soluble vitamins such as A,D and E. The difference between the two subtypes defines the vitamins as well as the potential of toxicity with supplementation. Water- soluble vitamins are readily dissolved in water-based environments such as blood, and get excreted if there is excess. Fat-soluble vitamins, on the other hand, are stored in fatty tissue and can accumulate to dangerous and toxic levels with over use.

Since vitamins and minerals are essential in metabolic processes, deficiency can result in various clinical conditions and, neurological derangements in addition to disruption of several other elements such as mood and sleep that can be easily reversed with replacement (30,31,32,33). Some mineral supplementation such as Zinc has been demonstrated to decrease the duration and symptoms of common conditions such as upper respiratory infections (35).

Anti-oxidants

Anti-oxidants are compounds that help the body neutralize toxins and free radicals. Commonly fortified in IV wellness therapy, these ingredients have reported effects of organ protection, toxin reduction, and even anti-aging properties. Glutathione, N-acetylcysteine (NAC), and Co-enzyme Q10 (CoQ10) are the most common anti-oxidants used. Glutathione aids in cellular protection and studies have shown a correlation between Glutathione levels and tissue health and function (11,12,13). Glutathione exists in the body in two forms, active and inactive. During the detoxification process, glutathione is converted from the active to inactive form. NAC acts as a catalyst in aiding the body regenerate the active form of glutathione.

As research proves more disease states manifesting from glutathione deficiency, glutathione replacement therapy either directly or indirectly via regeneration from NAC will continue to be a helpful as a therapeutic strategy as demonstrated by the kidney protective benefits reported in clinical studies in patient receiving NAC (36, 37). As a peptide, oral ingestion of glutathione results in almost complete breakdown, so the only viable form of replenishment is via intramuscular or intravenous supplementation (18).

Finally, the aging process, is thought to be correlated with changes in the balance of glutathione and other anti-oxidants. CoQ10 supplementation has been demonstrated to promote skin tissue and protein regeneration which plays a role in skin elasticity and Glutathione fortification is reported to have skin lightening and rejuvenation effects by decreasing skin melanin index, suppressing wrinkle formation and improving skin smoothness (38,39,40,41).

Lipotropic Compounds and Amino Acids

Lipotropic compounds and amino acids are the final commonly used ingredients in IV wellness therapy. Lipotropic means movement of fat and the compounds commonly refer to the combination of Methionine, Inositol and Choline. Studies have shown supplementation to promote weight loss by decreasing fat storage, increasing metabolism, and preventing cholesterol buildup (42,43,44). Other literature have reported that supplementation of lipotropic agents not only helps prevent liver problems, but reduces liver fat storages. (19,20).

The injections of amino acids and lipotropic co-factors are thought to function synergistically. Amino acids are the building blocks of protein, which is required for bodily function and processes. Different amino acids have different properties. A subset called the branched chain amino acids (BCAA), is thought to be involved in endurance activities by limiting protein degradation, while enhancing mental and physical performance. Supplementation has been demonstrated to help build muscle and augment energy levels and endurance capacity (45,46,47).

In conjunction with vitamins, anti-oxidants, minerals, and hydration, the use of lipotropic compounds and amino acids have been demonstrated to help regulate sleep and mood, appetite and energy (21, 22,23).

All of the above ingredients can be supplemented in three primary ways, orally, intramuscularly (IM) and intravenously. Oral ingestion results in slower absorption and delivers only a fraction of the available compound to the body compared to IM or IV use. As a result much larger doses have to be consumed more frequently to achieve the same concentration. IV replacement is most efficient in raising nutrient levels, but can subsequently drop off due to the excretion by the body. Thus IV drips administered in conjunction with intramuscular injection is ideal because it rapidly replaces levels, but then has a continuous supply as a result of the intramuscular depot. Finally, certain compounds can also be administered topically by means of creams or lotions. This augments local concentration of the supplement but typically does not have any significant systemic impact.

IV / IM Wellness And Aesthetics

The health status of a person can frequently be reflected physically. This not only refers to organic health but also mental health. Internal disruption of balance can occur from various factors including dehydration, fatigue, toxin accumulation, allergies, illnesses… Frequently overlooked, this internal derangement often has physical manifestations as evidenced by suboptimal appearance for most people in times of physical or mental stress. Even though modern technology and developments have various topical and aesthetic solutions, they traditionally address appearance from the outside and frequently disregard internal disequilibrium. Novel therapies such as hormone replacement therapy are now becoming increasing popular and highlighting the connection of internal derangement and physical appearance. Administration of IV nutrient and wellness therapy not only can help restore balance and benefit overall health, but frequently results in an enhanced cosmetic response for the recipient.

In summary, IV drip therapies have various benefits and applications. As the awareness and demand increases for these services, more and more IV clinics and medspas will emerge as they already have in cities such as Johannesburg, London, Los Angeles, Miami, Las Vegas, and New York. IV therapy is the future of wellness as time becomes ever more of the essence and people have less time to adhere to traditional recommended lifestyle of diet, rest and exercise. IV/IM wellness therapies are easy and safe to incorporate into existing lifestyle practices and serve as an innovative holistic adjunct to health and beauty.

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