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IV Nutrition Therapy (IVNT) Composition and Formulation
Designed & Programmed by Hyunsuk Frank Roh, MD, IVNT Certified by KMINT

This table is designed to calculate osmolarity when formulating IV Nutrient Therapy (IVNT) solutions. It allows healthcare providers to input nutrient components and automatically calculates the total volume and osmolarity of the selected nutrients and diluents. By ensuring the solution remains within safe osmolarity ranges, the table helps minimize complications like hemolysis or phlebitis. Additionally, it recommends optimal diluents and volumes based on the final osmolarity, keeping the solution isotonic or within acceptable hypertonic levels.

The table also offers guidance on pH correction using Sodium Bicarbonate, particularly for complex mixtures like the Meyer's Cocktail. A suggested administration sequence is outlined, starting with a “Warm-Up” phase (e.g., Glutathione), followed by the Meyer's Cocktail, and ending with a “Cool-Down” phase (e.g., Alpha Lipoic Acid), supporting a smooth and effective administration process for healthcare providers.

Order Medication Classification mg/mL pH Rec Dosage mL mOsm/mL Total mOsm Description
1. Warm-Up Glutathione
(Given Separately)		 Antioxidant 200 6.5 600~2,000 mg 1.2 0.00

Glutathione with 10cc N/S, slow IV push over 2 minutes.

Often combined with Laennec and Declage (diclofenac sodium).

Indication: Enhances antioxidant defense, detoxification, immune modulation, neuroprotection, and skin health. Supports oxidative stress reduction, liver function, neurodegeneration prevention, and adjunctive therapy in cancer recovery by reducing chemotherapy-induced toxicity.

⚠️ Contraindications & Cautions: Avoid in asthma (risk of bronchospasm), hypersensitivity, pregnancy, and breastfeeding (safety unknown). Use with caution in chemotherapy (potential interference), iron overload disorders (affecting iron metabolism), and renal dysfunction (oxidative stress risk).
2-1. Meyer's Cocktail Components VitC (Ascorbic Acid: C₆H₈O₆) Vitamin (Acidic Form) & Anti-Oxidant 500 6.61 1~100 5.34 0.00

❌ Prohibited with Selenium (Se) or multi-mineral formulations due to potential adverse interactions

Suggested Remedies for Complications from High-Dose IVC:

  • Magnesium Sulfate (MgSO₄): High sodium content from Sodium Ascorbate can disrupt potassium balance. Adding magnesium helps correct this, alleviating dyspnea and vascular pain.
  • Calcium Gluconate: Treats acute hypocalcemia (dyspnea, nausea). Restoring calcium often resolves these symptoms quickly.
  • Sodium Bicarbonate (NaHCO₃): Used for severe vascular pain during IVC, especially post-chemotherapy or radiation. Also relieves infusion-related pain from significant bruising. Continue NaHCO₃ until pain subsides; pause IVC for about three days to reduce inflammation before resuming.
  • Note: Never combine NaHCO₃ with Calcium Gluconate in the same IV bag due to precipitation.

Indication: mean corpuscular hemoglobin (↓ MCH), mean corpuscular hemoglobin concentration (↓ MCHC), and mean corpuscular volume (↑ MCV)

Physiology & Saturation: Plasma Vitamin C reaches saturation (~70–80 µM/L) at ~200 mg daily intake. Higher doses result in increased urinary excretion due to renal reabsorption thresholds (~1.4 mg/dL or ~80 µM). Total body stores of ~1500 mg are required for optimal saturation, while deficiency symptoms (e.g., scurvy) appear when stores drop below ~300 mg (~10 mg/day intake or less).

Potential Adverse Effects: High oral doses may cause osmotic diarrhea or gastrointestinal discomfort. For large IV doses, monitor for rare but potential risk of oxalate nephropathy in patients with renal dysfunction.

Clinical Rationale: This is the acidic form of Vitamin C. Useful for high-dose IV therapy, but may increase risk of vein irritation unless buffered. Monitor pH closely when administering large doses.

Cautions & Contraindications:

  • G6PD Deficiency: Risk of hemolysis with high-dose IV Vit C. A G6PD assay (e.g., fluorescent spot test) is recommended beforehand.
  • Gout or Hyperuricemia: Can influence uric acid levels; use cautiously if history of gout.
  • Renal Failure: Risk of hyperoxalemia and worsening renal function.
  • Chemotherapy Interactions: May diminish efficacy of certain agents (e.g., methotrexate, bortezomib). Monitor or separate timing.
  • Glutathione (GSH) or NAC: Potential antagonistic effects on redox balance are debated; some protocols avoid co-administration.
Sodium Ascorbate (C₆H₇NaO₆) Vitamin (Buffered Form) 500 7.20 1–100 mL 4.92 0.00

A buffered form of Vitamin C with a higher pH, reducing vein irritation. Commonly used in high-dose IV Vitamin C protocols to improve patient comfort and tolerance.
MgSO₄ Mineral 100 6.8 1~20 0.424 0.00 ⚠️ Combining with either i) Calcium Gluconate or ii) Thioctic Acid may cause precipitation, not recommended unless used immediately.
Vitamin B1 (Thiamine, Fursultiamine) Vitamin 100 2.5 - 4.5 1~2 2.22 0.00
VitB2 (Riboflavin) Vitamin 10 5 - 6 1~2 0.345 0.00
VitB3 (Niacin) Vitamin 100 5 - 7 1~2 1.22 0.00
VitB5 (Dexpanthenol) Vitamin 250 5.48 1~4 1.931 0.00
VitB6 (Pyridoxine) Vitamin 50 4.21 1~4 0.473 0.00
VitB12 (Cyanocobalamin) Vitamin 1 4.5 - 5 1~2 0.183 0.00
2-2. Suitable for mixing with Meyer's Cocktail Glycyrrhizinate (Hishiphagen-C) Herbal Extract 23 6.9 10~100 0.298 0.00

BP↑ i) Glycyrrhizinate ii) L-Carnitine

❌ Incompatible with Multi-Mineral

Supports liver protection (lowers AST/ALT, stabilizes hepatocytes), modulates immunity (reduces IL-6, TNF-α), exhibits antiviral activity (HBV, HCV, influenza, herpes), enhances antioxidant defense & adrenal support (boosts glutathione, prolongs cortisol), and protects gastric mucosa & skin (reduces inflammation, allergies).

⚠️ Caution: May raise BP, cause sodium retention, hypokalemia; avoid in hypertension, kidney disease, prolonged use.
Ginkgo Leaf Dried Ext. Herbal Extract 3.5 6.39 — 0.895 0.00

BP↓ i) Ginko ii) Arginine iii) MgSO₄ lower blood pressure via vasodilation.
Laennec (Human Placenta Hydrolysate) Regenerative Therapy 7.8 6.5 1~8 0.288 0.00

Supports liver regeneration, wound healing, immune modulation, and skin rejuvenation. Rich in peptides, amino acids, and growth factors.

⚠️ Caution: Avoid in patients with hormonal-sensitive conditions, pregnancy, or history of allergic reactions. Regulatory restrictions may apply.
Dipeptiven (L-Alanyl-L-Glutamine) Amino Acid 0.2 5.79 50 mL 0.921 0.00

For acute gastroenteritis, infuse 110 mL N/S with Dipeptiven and 1–2 ampoules of Laennec.

If glutamine is low, patients may experience muscle wasting, depression, hyperammonemia, and decreased gut function. Replenishing glutamine helps in the glucose–glutamine cycle, increases insulin secretion and insulin sensitivity, enhances fatty acid oxidation, and reduces inflammatory response. It also protects GI epithelial tight junctions and is beneficial in cancer-associated cachexia.

CIx: Use with caution or avoid in renal insufficiency, hepatic insufficiency, or metabolic acidosis.
Arginine Amino Acid 600 5.25 2–25 mL 4.73 0.00

N/S 110 mL with 150g Arginine and Vitamin B1 – Muscle recovery, energy production.

N/S 110 mL with 150g Arginine and Zinc – Male sexual health, cold extremities.

N/S 110 mL with 150g Arginine, Zinc, and Magnesium – Migraine relief.

Note: Arginine may worsen shingles and herpes simplex.
L-Aspartate-L-Ornithine Amino Acid 300 6.50 1–10 mL 1.800 0.00
S-Adenosyl‑Methionine (SaMe) Methyl Donor / Amino Acid Derivative 20 7.71 5–10 mL 0.426 0.00

❌ Incompatible with Ginkgo biloba and Calcium Gluconate
Apo-Choline Lipotropic 250 6.7 1~5 1.915 0.00
L-Carnitine Amino Acid 200 6.47 5–10 mL 2.158 0.00
NAC (N-Acetylcysteine) Antioxidant 100 6.83 1~9 1.353 0.00
2-3. Caution required when mixing with Meyer's Cocktail Calcium Gluconate Mineral 100 6.59 1~4 0.29 0.00

⚠️ Combining with Magnesium (Mg) may cause precipitation, not recommended unless used immediately.

Combination with Sodium Bicarbonate is generally discouraged, but in cases of vascular irritation, mix 2cc of Sodium Bicarbonate and use immediately.
Zinc Mineral 1 3.1 1~10 0.025 0.00

❌ Incompatible with Sodium Bicarbonate

Injections may cause pain due to acidity; for vascular pain, 2cc of 2% lidocaine may be administered for relief.

Usually mixed with normal saline (N/S) or as part of Meyer's cocktail

N/S 110 mL with 150g Arginine and Zinc

N/S 250 mL with Zinc, Magnesium, and Vitamin B12

Supports immune function, wound healing, antioxidant defense, hormonal balance, neurological health, gut integrity, and metabolic regulation, making it beneficial for infections, inflammation, tissue repair, and chronic diseases.

Supports inner ear function and may help with tinnitus, especially in zinc-deficient individuals, by promoting cochlear health, neurotransmitter balance, and antioxidant protection.

⚠️ Caution: Excess zinc may cause copper deficiency, nausea, immune suppression, or GI discomfort, and should be used cautiously in renal impairment or high-dose long-term therapy.
3. Cool-Down Thiotic Acid
= Alpha Lipoic Acid
(Given Separately)		 Antioxidant Lipid 30 7.1 100~600 mg 0.15 0.00

⚠️ Combining with Magnesium (Mg) may cause precipitation, not recommended unless used immediately.

300–600 mg Thiotic Acid + Fursultiamine in 100cc N/S, IV infusion.

500cc D5W mixed with Alpha Lipoic Acid, infused over 15 minutes.

Often mixed with Acetaminophen 100mL and Vitamin B12 for pain control.
Others Se (Selenium)
(Given Separately)		 Mineral & Anti-Oxidant 0.5 6.2 100~200 mcg 0.002 0.00

Forms inactive complexes (e.g., with mercury), reducing its toxicity. Administer selenium IV or orally in tandem with chelators. Monitoring selenoprotein levels and overall redox status is recommended.
Multi-Mineral Mineral N/A

❌ Should not be combined with i) glycyrrhizinate, ii) sodium bicarbonate, or iii) Vitamin C.

However, mixing with amino acids is encouraged, as it reduces pain and precipitation. For example, MultiMineral combined with Arginine solution shows better compatibility.

Injections may cause pain due to acidity; for vascular pain, 2cc of 2% lidocaine may be administered for relief.
Ca-EDTA Chelation Chelator 200 6.5 1–3 g 0.70 0.00

Particularly effective for lead chelation (Pb) and may help improve mild to moderate renal dysfunction by reducing lead burden. It also can reduce iron overload to some extent. However, for mercury (Hg), Ca-EDTA alone is insufficient—combine with alpha-lipoic acid (ALA), glutathione, and selenium (separately) for broader heavy metal detox.

EDTA Dose (mg) = (50 mg/kg) × LBW × CrCl / 100

  • LBW = Lean Body Weight (kg)
  • CrCl = Creatinine Clearance (mL/min)
    Estimated using the Cockcroft–Gault equation:
    For males: CrCl = [(140 − age) × LBW] / (72 × serum creatinine)
    For females: Multiply the result by 0.85.

Why Ca-EDTA (vs. Na-EDTA)? Calcium-disodium EDTA minimizes the risk of hypocalcemia seen with Na-EDTA (which can chelate patients’ own calcium). Ca-EDTA still effectively binds certain heavy metals without stripping too much calcium from blood.

Typical Protocol: Ca-EDTA is often mixed with lidocaine, Vitamin C, MgSO4, B5, B6, and B12 in a single IV bag. Adjust volume/diluent so final osmolarity and pH are safe. Infuse slowly over 1–2 hours, monitoring vital signs.

Measuring Heavy Metals: Common tests include whole blood levels, RBC metals, 24-hour urine, or “challenge tests” (collect urine after chelator dose). Interpretation varies; consult standard references to confirm deficiency vs. toxicity thresholds.
Thymosin α1 Immunomodulator N/A ~6.0 1.6 mg (typical) or per protocol 0.00 0.00

Route: SQ or IM injection (not typically given IV). Often used 2–3 times per week for immune modulation (e.g., post-viral fatigue).

Clinical Notes: Enhances T-cell function, supports antiviral defense, and modulates immune balance. Monitor for injection-site reactions.

Viscum album (Mistletoe Extract) Immunomodulator N/A ~6.0 Dose depends on brand and protocol (1–20 mg SC) 0.00 0.00

Route: Typically Subcutaneous (SC)

Injection-Site Reaction: A local dermal response < 5 cm in diameter is generally considered normal and indicates desired immunologic activity.

Common brands: Iscador®, Abnoba Viscum®, Helixor®.

Clinical Notes: Used as adjunctive therapy in oncological or immunomodulatory protocols. May improve quality of life, reduce side effects from chemo/radiation, and enhance immune cell activity.

IV Iron (Monofer®, Ferinject®) Iron Supplement 50 6.5–7.0 500–1,000 mg 2.00 0.00

How to Decide: Use the “Differential Diagnosis Table for Anemia Types” to confirm iron deficiency (low ferritin, high TIBC, microcytosis) versus inflammation, renal disease, or hypometabolic states. If labs confirm true iron deficiency, calculate total dose using the Ganzoni Formula:

Dosage Calculation (Ganzoni Formula):
Required iron (mg) = BW (kg) × (Target Hb − Actual Hb) (g/dL) × 2.4 + Iron stores (~500 mg).

Indications: Rapid correction of iron deficiency anemia, especially in CKD (chronic kidney disease), heavy menstrual bleeding, or post-partum anemia.

Contraindications: Known hypersensitivity to iron complexes, active infection, iron overload states (hemochromatosis). Caution in acute inflammatory conditions.

Clinical Notes:

  • Distinguish normal post-infusion skin staining from extravasation or allergic reaction.
  • Monitor for infusion-related reactions (rash, hypotension) and maintain resuscitation equipment nearby.
  • Evaluate iron deficiency vs. inflammation vs. renal disease vs. hypometabolic status (chronic illness) for correct diagnosis.
Omegaven (Omega-3 PUFA) Lipid Emulsion 100 8.0 100–200 mL 0.30 0.00

Clinical Uses: Often employed in parenteral nutrition, beneficial for some cancer patients (pancreatic & gastric), and may assist in amyloid-beta clearance. It provides anti-inflammatory effects via Omega-3 fatty acids.

Contraindications & Cautions: Use cautiously in patients with platelet aggregation problems (e.g., coagulopathies), severe hyperlipidemia, or if there are concerns about fat overload syndrome. Monitor triglyceride levels and clotting parameters.

Infusion Method: Generally administered as a separate infusion or within TPN (not mixed with Meyer's Cocktail). Infuse over several hours to minimize side effects.
Finehera
(Human Placenta Hydrolysate)		 Regenerative Therapy 7.8 6.5 1~8 mL 0.288 0.00
Ferinject
(Ferric Carboxymaltose)		 Iron Supplement 50 6.5–7.0 500–1,000 mg 2.0 0.00
Diluents Sodium Bicarbonate Alkalinizer 84 8.3 1~2 1.621 0.00

❌ Incompatible with Sodium Bicarbonate

  • Copper Gluconate: Precipitates as Cu(OH)₂ and CuCO₃.
  • Zinc: Forms insoluble Zn(OH)₂, reducing bioavailability.
  • Amino Acids: Undergo precipitation, denaturation, and loss of solubility.
  • Alpha Lipoic Acid: Becomes unstable in high pH, leading to degradation.
Diluent 9 6 — 0.296 0.00
Results and Recommendations Total — — — — 0.00 — 0.00
Final Osmolarity 0.00 mOsm/L
Recommended Diluent and Volume N/S: 0 mL - 0 mL | SterileWater: 0 mL - 0 mL | 5DS: 0 mL - 0 mL | 5DW: 0 mL - 0 mL | Half Saline: 0 mL - 0 mL | Amino Acid 5%: 0 mL - 0 mL | Amino Acid 10%: 0 mL - 0 mL
Final pH 7.00
Recommended Sodium Bicarbonate 0 mL


Osmolarity Color Scheme

A simple, intuitive visual guide is integrated into both tables to inform users about the osmolarity levels of their calculated solutions. The color-coded system ranges from red (high risk of adverse effects due to hypo- or hypertonicity) to green (safe isotonic solutions), providing immediate feedback on the suitability of the solution for peripheral or central administration.

Osmolarity Range (mOsm/L) Color Interpretation
< 200 Red Hypotonic - High risk; adjust diluent volume.
200 – 239 Yellow Hypotonic - Use with caution; monitor for hemolysis.
240 – 340 Green Isotonic - Safe for peripheral administration.
341 – 500 Yellow Slightly hypertonic - Use with caution; monitor for phlebitis.
501 – 900 Orange Hypertonic - Central venous access recommended.
> 900 Red Highly hypertonic - High risk; adjust diluent volume.


Examples of IV Nutrition Therapy (IVNT)

Upon Cough:

Upon Post-Corona Syndrome:



Synergistic Antioxidant Network: How Vitamin C, Glutathione, Alpha-Lipoic Acid, and CoQ10 Work Together

                      +-----------------+
                      |                 |
        (1)  Ascorbate (AscH-)  --->   |   Free Radical Neutralization
                      |                 |
                      +--------v--------+
                               |
                               | (AscH- becomes DHA)
                               v
                     +---------------------+ 
                     |  Dehydroascorbic    |
                     |    Acid (DHA)       |
                     +---------------------+
                               | (2) Reduced back to AscH- by GSH or ALA
                               v
                     +---------------------+
                     |     Glutathione    |
                     | (GSH <--> GSSG)     |
                     +---------------------+
              (4) /                           \
                 /  (3) ALA can reduce GSSG    \
                /     back to GSH               \
               v                                 v
      +-------------------+           +-------------------+
      | Alpha-Lipoic Acid|           | CoQ10 (Ubiquinone)| 
      |  (ALA <--> DHLA)  |<--(5)-->  | (CoQ10 <--> CoQH2)|
      +-------------------+           +-------------------+
                ^                                 ^
                |--------------(6)----------------|
                |    NAD(P)H from mitochondria    |

Key Steps & Synergies:

  1. Vitamin C (Ascorbate) Scavenges Free Radicals: Ascorbate (AscH⁻) donates electrons to neutralize free radicals, becoming dehydroascorbic acid (DHA).
  2. Regeneration of Ascorbate: DHA is reduced back to active ascorbate by either Glutathione (GSH) or Alpha-Lipoic Acid (ALA), ensuring continuous antioxidant protection.
  3. Role of Alpha-Lipoic Acid: ALA (in its reduced form, dihydrolipoic acid or DHLA) can regenerate antioxidants like GSH, Vitamin C, and even Vitamin E. It also helps maintain the glutathione pool by converting oxidized glutathione (GSSG) back to GSH.
  4. Glutathione’s Thiol Cycle: Glutathione (GSH) reduces DHA and other oxidized species, then becomes GSSG. NADPH (produced primarily in the pentose phosphate pathway) reconverts GSSG back to GSH. ALA can also assist in this reduction.
  5. CoQ10’s Electron Carrier Function: CoQ10 (ubiquinone) is reduced to CoQH₂ (ubiquinol) in the mitochondrial electron transport chain. Ubiquinol can help regenerate other antioxidants and maintain the redox balance within cells.
  6. NAD(P)H as Reducing Power: Both NADH (in mitochondria) and NADPH (in cytosol) supply the necessary electrons for regenerating ALA (DHLA form) and reducing GSSG back to GSH.

Together, these molecules form a network: Vitamin C reduces free radicals; Glutathione and Alpha-Lipoic Acid recycle oxidized Vitamin C; CoQ10 supports mitochondrial electron transport (producing NAD(P)H) and can help regenerate other antioxidants. By targeting multiple steps in the oxidative stress pathway, their combined use can maximize antioxidant capacity more effectively than using any single agent alone.



Differential Diagnosis Table for Anemia Types

Parameter Iron Deficiency Inflammatory / ACD Renal Disease Hypometabolic Status
MCV (Mean Corpuscular Volume) ↓ (Microcytic) Normal or ↓ (Normocytic / Mild Microcytosis) Usually Normal (Normocytic) Variable (Often Normal; can be Low if malnourished)
RBC Morphology Microcytic, Hypochromic Normocytic or Slightly Microcytic Normocytic, Normochromic May be Normocytic but Hypochromic if protein/energy deficient
Serum Iron (SI) ↓ ↓ or Normal ↓ ↓ or Normal
TIBC (Total Iron Binding Capacity) ↑ (High) Normal or ↓ Normal or ↓ Normal (may be ↓ in severe malnutrition)
Transferrin Saturation ↓ (Low) ↓ or Normal ↓ Normal or Slightly ↓
Serum Ferritin ↓ (Low) Normal or ↑ (Acute Phase Reactant) Normal or ↑ (especially if inflammation) Normal or ↓ if severe deficiency
Other Notes Very low ferritin
↑ RDW (Red Cell Distribution Width) 		↑ CRP or ESR (markers of inflammation)
Ferritin can be “falsely” high 		↓ Erythropoietin (EPO) production
Elevated urea/creatinine (low GFR) 		Often linked to protein-energy malnutrition
Thyroid or adrenal issues can coexist


Drug-Induced Nutrient Depletion

Table: Common Classes of Acid-Suppressing Agents and Associated Nutrient Depletions

Drug Class Mechanism Key Nutrient Depletions Examples
Antacids Neutralize stomach acid Calcium, Phosphorus, Copper, Iron, Magnesium, Potassium, Zinc Over-the-counter formulations such as
aluminum hydroxide,
magnesium hydroxide
H₂ Receptor Antagonists Block histamine H₂ receptors in the stomach Vitamin B₁₂, Vitamin D, Folic Acid, Zinc, Intrinsic Factor Ranitidine, Famotidine, Nizatidine
Proton Pump Inhibitors Inhibit the H⁺/K⁺ ATPase enzyme in parietal cells Vitamin B₁₂, Protein, Minerals Omeprazole, Lansoprazole,
P-Cap (Prozan), Kcab (Tegoproazon),
Fexuclue (Fexuprazon)


Functional Biomarkers of Oxidative Stress (Dr. Weatherby’s Criteria)

Elevated Biomarkers

Reduced Biomarkers

Increased neutrophil-to-lymphocyte ratio (NLR) is associated with insulin resistance.



Acknowledgement

This document consolidates and summarizes dispersed information. However, it does not guarantee accuracy or assume any responsibility for patient outcomes. As a physician, you are solely responsible for the decisions and outcomes when following this guidance.



Reference

  1. Brunton, L. L., Knollmann, B. C., & Hilal-Dandan, R. (2018). Goodman & Gilman's: The pharmacological basis of therapeutics (13th ed.). McGraw-Hill Education.
  2. Gaby, A. R. (2002). Intravenous nutrient therapy: the "Myers' Cocktail". Alternative Medicine Review, 7(5), 389-403.
  3. GlobalRPh Inc. (n.d.). Osmolarity calculator: Extremely powerful tool. GlobalRPh. Retrieved from https://globalrph.com/medcalcs/osmolarity-calculator-extremely-powerful-tool/
  4. Korea Institute of Nutritional Medicine. (n.d.). Osmolarity calculator. Korea Institute of Nutritional Medicine. Retrieved from https://www.kinm.or.kr/info4.html?category=3
  5. Korean Medical Society for Intravenous Nutrition Therapy. (2024). [Handout, Book and link]. Distributed at the Korean Medical Society for Intravenous Nutrition Therapy biannual meeting. Retrieved from http://www.kmint.org/bbs/board.php?bo_table=0405&wr_id=7.
  6. Kim, J.. (2022). 바로 시작하는 IVNT 정맥주사영양치료. Docters Book.
  7. Pizzorno, J. E., & Murray, M. T. (2020). Textbook of natural medicine (5th ed., 2-volume set). Churchill Livingstone.


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