Virginia Osborne, ND
As NDs we are often confronted with chronic diseases that precipitate, or are precipitated by, inflammation. These are the cases that often lead us to determine that IV (intravenous) therapeutics will be useful in the treatment plan. With basic labs in hand (CMP, CBC and lipid profile) along with clinical signs and symptoms, a process of determining the most beneficial injectables can take place.
Conditions that most optimally respond to IV therapeutics often include arthritis, fibromyalgia, chronic fatigue, flu and flu like symptoms, cancer, chemical and heavy metal toxic related diseases, as well as many others. These conditions can be generated from lifestyle choices, unwarranted exposures, travel, chemical exposure or warfare, and many other factors.
When considering the benefits of injectables, the source of the discomfort or disease presentation aids in deciding the most appropriate amounts and selection of injectables. Multiple vitamins in any infusion will aid in biochemical processes that have slowed down during illness. The addition of basic vitamins to most IV protocols becomes the base upon which the rest of the protocol can be designed.
Some specific parenteral nutrients and the conditions they benefit are identified below.
Magnesium
Cardiac arrhythmias and angina, asthma, hypomagnesemia-induced “leg cramps,” diabetic-related discomforts, reduced platelet activity, and preeclampsia are a few common indications for IV magnesium. Magnesium is present in over 300 enzymatic systems integral to ATP (adenosine triphosphate) metabolism.1 Sodium and potassium require magnesium for its transmembrane exchange. Hypokalemia (arrhythmias) cannot respond to supplementation until magnesium deficiency is corrected.1 Notably, many arrhythmias demonstrate magnesium deficiency in electrocardiographic findings, automaticity irregularity, and other signs in the condition.2-7
Asthmatic or reactive airway conditions (acute or chronic) show benefits through increased amounts of magnesium. When used in the parenteral form, magnesium can bring ready relief. This can be accomplished by adding to the vitamin/mineral protocol either 3000 mg (6mL) of magnesium sulfate in a 500 mL drip, or 4cc of 500 mg/mL as an IV push. Use caution when infusing due to the potential for overdosing. Keep calcium gluconate or chloride (1 g IV push) for such an emergency. As demonstrated in 2 studies, magnesium infusions increased the forced expiratory volume in 1 second (FEV1); the mechanism of the bronchial tree requires further research.9 However, it has been suggested that on the bronchial level there is smooth muscle relaxation. We know that magnesium has a similar effect through the influence on vascular smooth muscle by way of calcium channel reduction (slowing the ability of these channels to import calcium).8
DMSO
Arthritis, cardiac conditions, cancer, chemical toxicity, Alzheimer’s dementia, diabetic ulcers, neuropathic pain, scar tissue and strokes are often indications for the inclusion of DMSO in a formula. As a hydrogen bond disruptor DMSO diminishes inflammation by reducing free radicals, which is demonstrated by its ability to prevent oxidation of lipoproteins. Further, it increases the sensitivities (acts as a synergist) with the nutrients and pharmaceuticals it is combined with by causing more rapid tissue uptake of nutrients across cell membranes and the blood brain barrier. It is best given in large volumes (250-500 mL normal saline or D5W, ie, vitamin/mineral IV infusion as a base) and infused at a slower rate to avoid side effects of phlebitis or phlebalgia.
There are hundreds of articles that have been written on the mechanism of action and clinical benefits of DMSO for arthritis conditions.9,10 This benefit of DMSO includes rheumatoid as well as degenerative types of joint disease. In some literature it has been clinically demonstrated to improve the outcome of CVA when treated shortly after the incident. As previously mentioned, it can and will enhance the nutrient IVs, hydrogen peroxide, and chelation infusions. Caution: dose is not to exceed 0.3 g/kg of body weight, keeping in mind a less than 10% concentration in the IV solution. As a further caution to your patients, DMSO has a strong sulfur odor, which they (and their partner) will “notice” for up to 2 days.
MSM
Arthritis, discogenic back pain, fibromyalgia, and scleroderma are some of the conditions which patients report benefit from MSM parenteral infusion.
MSM is produced by conversion from DMSO in the presence of hydrogen peroxide. It is a mild nontoxic substance produced biochemically or in compounding laboratories.
The treatments require 100 mL each and can be combined with many of the vitamin/nutrient protocols. With the many protocols available, be aware that the clinical studies done were only with this substance, and will take many weeks if not months to show benefit. Combined with other modalities the length of time to improvement is reduced.
MSM with the reduced sulfur molecule does not have the “eau de DMSO.”
Alpha Lipoic Acid
Appropriate conditions to consider alpha lipoic acid (ALA) IV include diabetes, cancer support, peripheral vascular disease, peripheral neuropathy, neurodegenerative conditions (when given with added methylcobalamin), radiation protection, Amanita mushroom poisoning, hepatitis C, HIV, and heavy metal toxicity.
ALA is a powerful antioxidant/free-radical scavenger that crosses the blood brain barrier. It increases the cytotoxicity of high-dose IV ascorbate by increasing GLUT (glucose transporter) receptor sensitivity and ascorbate uptake into cells, and it recycles glutathione in red blood cells and lymphocytes. ALA is well known for treatment in diabetic peripheral neuropathy, and it enhances glucose metabolism.
Cautions: This is one substance that has been known to precipitate when combined with other injectables. It is best administered away from other injectables in its own solution of 250 mL D5W. The IV bag or bottle needs to be covered during infusion, as ALA in the presence of light breaks down quickly. Long-term use may lead to thiamine deficiency,
Phosphatidylcholine
Cardiac and liver conditions, heavy metal and chemical toxicity, neurodegenerative, and depleted conditions all may be aided by the addition of phosphatidylcholine (PTC) to IV therapies. PTC enhances cell membrane function and fluidity and potentially relieves toxic buildup within the cell, thereby diminishing inflammation and pain. PTC reduces cholesterol systemically and can be hepatoprotective by improving overall tissue/cell structure for improved oxygenation.
Vitamin C/Ascorbate (ASC)
With all that we know about the benefits of ascorbate (ASC) this information will be limited to emphasizing the reduction of pain through enhancing immune activity. This enhancement can be seen in the ability of ASC in reducing free radical damage, improving oxygenation and enhancing antioxidant pathways. One key area of ASC activity is that of glutathione reduction and hydrogen peroxide breakdown, causing reduced inflammation and pain levels.
B Vitamins
B vitamins are added to IV formulas to aid in amino acid metabolism, cachexia, cancer, and muscle wasting conditions. They are also beneficial for immune-compromised patients due to cold and flu, cancer, autoimmunity, HIV, toxicity and the like. B Vitamins are implicit co-factors in chemical pathways whether normal or chemically altered.
Each individual should be evaluated to determine if the methyl pathways are deficient or altered (and require added amounts of methyl-B12 and folate), or if amino acid pathways are stressed (requiring more pyridoxine) or both. Cartilage and ligament damage would do well to have added dexpanthenol in the IV formula. Biotin is best added to vitamin/mineral protocols for bacterial/viral/fungal, chronic fatigue, fibromyalgia as well as chemical and heavy metal toxicity protocols. Caution is advised in initial parenteral B vitamins as a toxic patient may detoxify too quickly (due to increased pathway activity) and the individual may not be able to tolerate the symptoms. The risk of detoxification symptoms is best avoided by starting with lower doses of B vitamins and increasing the dose with each subsequent infusion.
Prevention of Discomfort and Pain During IV Infusion
It is best to establish prior to IV infusions what your patient’s pain tolerance is, as at anytime this tolerance could change during the infusion and healing process. Follow up after each infusion to determine how it was tolerated. Also consider the physiological state your patient is presenting with at the time of the infusion. Check in often with your patient throughout the infusion. Quickly resolving minor pain issues by slowing the rate, warming the site, or other means can deter a more painful event from occurring.
Virginia Osborne, ND is a graduate of NCNM, who lectures internationally on IV and EDTA therapies, and conducts IV seminars and emergency medicine workshops for the clinical practitioner. Her clinical practice is in Grass Valley, Calif. www.ivnutritionaltherapy.com.
References:
1. Fox C, Ramsoomair D, Carter C. Magnesium: its proven and potential clinical significance. South Med J. 2001;94(12):1195-1201.
2. Whang R, Hampton EM, Whang DD. Magnesium homeostasis and clinical disorders of magnesium deficiency. Ann Pharmacother. 1994;28(2):220-226.
3. McLean RM. Magnesium and its therapeutic uses: a review. Am J Med. 1994;96(1):63-76.
4. Seller RH, Cangiano J, Kim KE, Mendelssohn S, Brest AN, Swartz C. Digitalis toxicity and hypomagnesemia. Am Heart J. 1970;79(1):57-68.
5. Iseri LT, Chung P, Tobis J. Magnesium therapy for intractable ventricular tachyarrhythmias in normomagnesemic patients. West J Med. 1983;138(6):823-828.
6. Hampton EM, Whang DD, Whang R. Intravenous magnesium therapy and acute myocardial infarction. Ann Pharmacother. 1994;28(2):212-219.
7. Shechter M, Hod H, Marks N, Behar S, Kaplinsky E, Rabinowitz B. Beneficial effect of magnesium sulfate in acute myocardial infarction. Am J Cardiol. 1990;66(3):271-274.
8. Altura BM, Zhang A, Altura BT. Magnesium, hypertensive vascular diseases, atherogenesis, subcellular compartmentation of Ca2+ and Mg2+ and vascular contractility. Miner Electrolyte Metab. 1993;19(4-5):323-336.
9. DMSO. Japanese Rheumatism Association showing benefit in rheumatoid arthritis. Matsomoto – Annals of NY Academy of Sciences. 1967;141(1):560-569.
10. Jacobs S. OHSU, DMSO the current status. 2002.
