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  Published literature about vit C is
prolific

 Used frequently for detox, cancer and

infectious diseases

 How does vit C work to kill pathogenic

and cancerous cells while sparing the
healthy ones?

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  Sodium ascorbate for IV use is buffered
with sodium bicarb for a neutral pH
 The osmolarity of sodium ascorbate is
very high, about 6 mOsmol / mL
 For doses under 25 g, it can be
successfully diluted in 250 cc of NS
 After 25 g, it is wise to use sterile water
 Good rule of thumb:
~ 25 g / 250 cc
~ 50 g / 500 cc
~ 75 g / 750 cc
~ 100 g / 1000 cc

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  Chemically, sodium ascorbate looks like sugar,
and can trick the pancreas into releasing a lot
of insulin

 This will happen as the dose of vitamin C

increases

 A snack and hydration before and/or during

and/or after infusion can reduce the effect of
hypoglycemia

 At higher doses, sodium ascorbate can have a

diuretic effect, which can cause dehydration,
so post-treatment hydration with dextrose 5%
(250cc or 500 cc) is useful

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  G6PD (glucose-6-phosphate
dehydrogenase) enzyme deficiency is
not common, but it is good practice
to be aware of it

 G6PD is X-linked recessive disorder

 Test the patient and know their status

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  Patients with G6PD deficiency can
have serious side effects with high
doses of vitamin C
~ RBC hemolysis
~ ARF
~ jaundice

 Fava beans, moth balls (naphthalene),

antimalarials, aspirin

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  Atthe bare minimum, check
the following labs:

~ CBC
~ UA
~ CMP
~ G6PD
~ Hemoglobinopathy Profile
~ RBC osmotic fragility

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  Vitamin C induces the formation of
peroxide in human cells

 Peroxide is very toxic to ALL cells, but

normal cells have a large supply of the
enzyme catalase (H2O2  H2O)

 Cancer cells are shown to have 10-100 X

less catalase than healthy cells

 So they cannot detox the peroxide and

thus die
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  Vitamin C has also shown to be very
anti-inflammatory and anti-oxidative

 Beneficialfor several medical

conditions such as coronary artery
disease, autoimmune disease,
fibromyalgia, viral and bacterial
infections, cancer, acute pancreatitis

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  Thepatient should get large
doses of vitamin C in all
pathological conditions while
the physician ponders the
diagnosis

– Frederick Robert Klenner , MD

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  When you infuse an IV, you directly
access the vascular (plasma)
compartment

 This quickly effects the ECF and ICF of

most cells

 Understanding the osmotic balances

between the compartments is essential to
proper and successful IV therapy

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  1) Water Soluble (B & C)
non-toxic and do not accumulate
however, transient nausea may occur
if infused too rapidly

 2) Fat Soluble (A, D, E, K, biotin)

available in “water-soluble” forms as
stable emulsions and can accumulate
at high doses and become toxic

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  IVvitamin C can be divided
into 2 major categories:

1) General immune and antioxidant support

~ These IVs contain support nutrients
and also GSH

2) Purely oxidative purposes

~ These IVs contain only minerals to balance the
blood’s electrolytes and not given with
supportive nutrients or GSH

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  Typical dose is 500 mg up to 200 g

 High dose is typically greater than 15 g

 Anything > 150 g is best suited for

inpatient facility and infused over 4 hours

 One of the most important principles in

molecular medicine is that one dose
does not fit all

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  Beware of fluid susceptibility in patients
with CHF, edema or ascites
 Total fluid volume and sodium load need
to be considered
 Extra sodium sources are sodium
hydroxide (pH adjustment of stock
ascorbate), sodium ascorbate, NaCl as
carrier solution
 Limit IV osmolarity to 1200mOsmol/L
when using peripheral veins to decrease
risks of sclerosing the veins

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  Higherosmolarities of 1500-1600
mOsmol/L can be used with central
lines

 Keep patient hydrated because

diuretic effect is magnified

 If infusion rate is too rapid, pain at IV

site can occur as well as infiltration

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  Ascorbicacid is a mild chelating
agent so watch calcium levels

 Lowcalcium can cause tremors

and fasciculations

 IVpush of 10 cc of calcium
chloride or calcium gluconate at
1 cc per minute
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  Remember! Sodium ascorbate is
structurally similar to glucose so do not
rely on glucometer reading during or
up to 6 hours after IV therapy with
vitamin C

 Make sure your diabetic patients are

aware of that or anyone who is to go
for lab testing (postpone it)

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  Renal insufficiency

 Long term hemodialysis patients

 Certain forms of iron overload

 Oxalate stone formation

(prevent this with 300 mg of Mg citrate
plus 10 mg of vit B6 po daily)

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  Ascorbic acid is classified as a
carbohydrate (hexose derivative)

 Stable in solutions below pH 4

 Instability increases as pH does

(oxidizes in the presence of oxygen and
metal catalysts such as iron or copper)

 Admixture should be refrigerated unless

administered in 30-45 minutes

 Freezing solutions are acceptable as well

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  Solutions
that remained at room
temp for 24 hours lost 60% of the
ascorbic acid

 Ascorbicacid is distributed in the

water soluble compartments of
the body

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  Excreted as ascorbic acid, oxalate,
dehydroascorbic acid, diketoglulonic
acid, ascorbic-2-sulfate, methyl
ascorbate etc
 Ascorbic acid acts as an antioxidant by
donating an electron to free radicals
and is oxidized to semi
dehydroascorbate
(semi dehydroascorbate, an ascorbyl radical, is
unreactive and so free radical reactions are
quenched

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  Two ascorbyl radicals combine and form
one molecule of ascorbate and one
molecule of dehydroascorbate

 Dehydroascorbate is devoid of two

electrons and thus becomes instable

 It then breaks down and forms oxalic

acid and L-threonic acid

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  Ascorbic acid can act as an oxidant most
notably in the presence of metal ions such
as iron.

 It is not a good idea to administer vitamin C

in the presence of iron overload.

 Ascorbic acid normally acts as a reducing

agent.

 Data does not support induction of pro-

oxidative effects in healthy subjects given
HDIVC.

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  Terminal cancer patients received 50 g
daily for 8 weeks and blood chemistry
testing revealed no evidence of toxicity
or adverse effects

 An Australian study showed that

physicians administered as much as
300 g daily and reported the results were
“spectacular” and the only notable side
effect was better health

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  Patientswith pre-existing medical
conditions may have a higher risk
for calcium oxalate stone
formation

 Ascorbic acid is not a risk factor in

and of itself for oxalate stones
under ordinary circumstances

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  In metastatic cancer, a small dose of 5 g
to 25 g in 250 cc of NS or sterile water
over 1 hour is recommended
 Always monitor patient closely for
adverse side effects
 Infusion rate should not exceed more
than 1 g per minute
 0.5 g / min is good rule
 Dose is adjusted to achieve transient
plasma concentrations of 300-400 mg/dl

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  Tumor mass size is most critical factor for
dose determination

 Body weight and size

 Caffeine consumption affects vitamin C

excretion

 Tobacco use / smoking increases

vitamin C requirements

 Alpha lipoic acid lends to increased

perfusion of vitamin C therefore less amount
of vitamin C is required

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  Treatment schedule 1-15, 2-3 x weekly

 Labs

 Start at 25 g then work up to 50 g then

75 g then 100 g etc

 Remember, there are no cookie-cutter

rules, you must customize for each
individual patient, these are just
guidelines

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  HDIVC should keep minerals (Ca, Mg, K)
esp sodium bicarb to prevent sclerosis,
but take B vitamins out (you can
administer separately later, like following
day)
 Why no B vitamins? Though they are
essential in cancer patients, they can
interfere with the oxidative effects of
vitamin C if given parenterally on the
same day, and same goes for
(glutathione (GSH)

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  The formulations for vitamin mixtures are as
varied and unique as the practitioners who
administer them

 One of the most popular and effective

ways to supplement micronutrients in
patients who need repletion for whatever
reason

 Simple as a “banana bag” administered in

ER to more complex ones to amino acids
lipids etc

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  Multi-vitamin
infusion which can
enhance the immune system,
reduce fatigue and inflammation,
treat migraines and myalgias and
autoimmune diseases, alleviate
hangovers, promote healing in
cancer and much more

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  Named for the late John Myers, MD, a
Maryland physician who used IV
injections of nutrients to treat many
chronic conditions

 IV micronutrient therapy, specifically the

Myers cocktail (varies) is a popular
approach for treating many medical
conditions amongst
integrative/functional/anti-aging
practitioners and is becoming quite
mainstream

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  After Myers death in 1984, many of his
patients sought treatment still.

 Was not clear what exactly he used but

it appeared it was a 10 mL syringe with
MgCl, , Ca gluconate, thiamine, B6, B12,
Ca pantothenate, B complex, C and
dilute HCl.

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  MgCl hexahydrate 20% (2-5 mL)
 Ca gluconate 10% (1-3 mL)
 Hydroxy or Methyl cobalamin B12
1000 mcg (1 mL)
 Pyridoxine hydrochloride 100 mg/mL B6
(1 mL)
 Dexopanthenol 250 mg/mL B5 (1 mL)
 B complex 100 (1 mL) contains 100 mg each of
thiamine and niacinamide and 2 mg each of
riboflavin, dexapanthenol, pyridoxine
 Vitamin C 222 mg/mL (4-20 mL)

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  All ingredients can be drawn into one
syringe and then 10-20 mL of sterile water
or more added to reduce hypertonicity

 IV can be infused over 10-15 min

depending on patient and their age and
their medical issues etc

 You can also mix ingredients in a bag of

sterile water

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  250 cc of sterile water
 12.2 mEq Mg
 5 mEq Na bicarb
 1 mg Zn
 2 mEq KCl
 100 mg pyridoxine
 1 mL B complex
 250 mg dexopanthenol
 5 mg methylB12
 25 g vit C

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  There are no hard, fast rules to determine who can
benefit from IV Myers

 Use your judgment and educate the patient

 Define the relationship between labs and

diagnoses and IV therapy

 Patients like to be reassured by the physician that

they are making the right choice and will benefit
from it

 IV therapy, like aesthetics, is instant gratification

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  Intravenous Nutrient Therapy:
The “Myers Cocktail” by Alan Gaby, MD

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