Banana bag

A banana bag (or rally pack) is a bag of IV fluids containing vitamins and minerals. The bags typically contain thiamine, folic acid, and magnesium sulfate, and are usually used to correct nutritional deficiencies or chemical imbalances in the human body. The solution has a yellow color, hence the term "banana bag".[1]

Composition

The typical composition of a banana bag is 1 liter of normal saline (sodium chloride 0.9%) with:[2]

  • Thiamine 100 mg
  • Folic acid 1 mg
  • Multivitamin for infusion (MVI), 1 ampule
  • Magnesium sulfate 3 g

The solution is typically infused over four to eight hours or as per physician's orders. The yellow color comes from folic acid and the multivitamin.[2] (The conventional composition is not optimal based on current evidence; see the Flannery et al. (2016) citation.)

Uses

Banana bags are often prescribed for alcoholics. Chronic alcoholism can lead to significant lack of thiamine, potentially causing Wernicke–Korsakoff syndrome. Chronic alcoholics can also suffer significant whole-body magnesium deficiencies.[1][3] However, recent evidence (2016) points that the amount of thiamine in a conventional banana bag is inadequate for prophylaxis and treatment for ICU patients. The proposed regimen is 200–500 mg IV thiamine every eight hours for the first day of admission. Less evidence exists for the use of magnesium and folic acid, for which a less radical change in dosage is proposed. No evidence for the use of multi-vitamins are found for alcoholics.[2] Vitamin C is proposed to be added based on the prevelance of low blood levels among alcoholics, but its theraputic usefulness is undefined.[4]

Banana bags are used in the intensive care unit to correct acute magnesium deficiencies, a common occurance in the ICU. Magnesium is stated to be beneficial for patients with terminal illness because deficiency can cause nerve pain and muscle cramps.[5]

Banana bags (more narrowly, thiamine) are under-used when alcoholics present to the hospital with illnesses other than alcohol withdrawal, especially for critical illnesses such as sepsis, traumatic brain injury, and diabetic ketoacidosis.[6] Using thiamine on septic alcoholics seems to reduce the rate of death.[7]

See also

References
  1. Jeffrey E Kelsey; D Jeffrey Newport & Charles B Nemeroff (2006). "Alcohol Use Disorders". Principles of Psychopharmacology for Mental Health Professionals. Wiley-Interscience. pp. 196–197. ISBN 978-0-471-79462-2.
  2. Flannery, Alexander; Adkins, David; Cook, Aaron (2016). "Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU" (PDF). Critical Care Medicine. 44 (8): 1545–1552. doi:10.1097/CCM.0000000000001659. PMID 27002274. S2CID 22431890.
  3. Merle A. Carter & Edward Bernstein (2005). "Acute and Chronic Alcohol Intoxication". In Elizabeth Mitchell & Ron Medzon (eds.). Introduction to Emergency Medicine. Lippincott Williams & Wilkins. p. 272. ISBN 978-0-7817-3200-0.
  4. Marik, PE; Liggett, A (10 May 2019). "Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders". Critical Care. 23 (1): 165. doi:10.1186/s13054-019-2435-4. PMC 6511125. PMID 31077227.
  5. Panahi, Y; Mojtahedzadeh, M; Najafi, A; Ghaini, MR; Abdollahi, M; Sharifzadeh, M; Ahmadi, A; Rajaee, SM; Sahebkar, A (2017). "The role of magnesium sulfate in the intensive care unit". EXCLI Journal. 16: 464–482. doi:10.17179/excli2017-182. PMC 5491924. PMID 28694751.
  6. Pawar, RD; Balaji, L; Grossestreuer, AV; Thompson, G; Holmberg, MJ; Issa, MS; Patel, PV; Kronen, R; Berg, KM; Moskowitz, A; Donnino, MW (February 2022). "Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study". Annals of Internal Medicine. 175 (2): 191–197. doi:10.7326/M21-2103. PMC 9169677. PMID 34871057.
  7. Hu, C; Wu, T; Ma, S; Huang, W; Xu, Q; Kashani, KB; Hu, B; Li, J (April 2022). "Association of Thiamine Use with Outcomes in Patients with Sepsis and Alcohol Use Disorder: An Analysis of the MIMIC-III Database". Infectious Diseases and Therapy. 11 (2): 771–786. doi:10.1007/s40121-022-00603-1. PMC 8960538. PMID 35169996.


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