Banana bag

Composition

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

• 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 the riboflavin in the MVI and the folic acid. (The conventional composition is not optimal based on current evidence; see the Flannery et al. (2016) citation.)

Uses

Alcoholism

Banana bags are often prescribed for alcoholics. Chronic alcoholism can lead to a lack of thiamine, potentially causing Wernicke–Korsakoff syndrome. Chronic alcoholics can also have magnesium deficiency.

A 2016 review found that the amount of thiamine in a conventional banana bag is inadequate for prevention or 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 smaller change in dosage is proposed. No evidence for the use of multi-vitamins are found for alcoholics. Vitamin C is proposed to be added based on the prevalence of low blood levels among alcoholics, but its usefulness is undefined.

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. Using thiamine on septic alcoholics seems to reduce the rate of death.

Intensive care

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

References

References

1. (2006). "Principles of Psychopharmacology for Mental Health Professionals". Wiley-Interscience.
2. (2005). "Introduction to Emergency Medicine". Lippincott Williams & Wilkins.
3. (2016). "Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU". Critical Care Medicine.
4. (10 May 2019). "Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders.". Critical Care.
5. (February 2022). "Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study.". Annals of Internal Medicine.
6. (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.
7. (2017). "The role of magnesium sulfate in the intensive care unit.". EXCLI Journal.