Guidelines for Treatment of Nutritional Deficiencies in Alcohol Use Disorder

1. 1. Discontinue using a banana bag 
   2. Thiamine 200-500mg IV every 8 hours (we recommend 500mg) 
   3. Magnesium Sulfate 64mg/kg IV on day 1 (approximately 4gms for females and 5gms for  males). Hold or modify if Mg 2-2.5 and/or Renal Insufficiency. Targeting a higher  concentration towards 2.2-2.5 is likely best 
   4. Followed by 32 mg/kg of magnesium on days 2-4, (approximately 2gms for females and 3gms  for males). Hold or modify if Mg 2-2.5 and/or Renal Insufficiency. Targeting a higher  concentration towards 2.2-2.5 is likely best 
   5. 400-1000ug Folate IV daily for several days 
   6. Consider alcoholic ketoacidosis and use dextrose containing fluids and avoid normal saline in  most patients (also watch for refeeding syndrome) 
   7. Consider adding a Multivitamin and other minerals if available to treat profound nutritional  deficiencies and rarer disorders. IV likely best over PO, at least initially 

Review Article Link: https://med-specialists.net/vitamin-and-mineral-supplementation-for-alcohol withdrawal-please-it-is-time-to-retire-the-banana-bag/ 

Educational Video Link: https://youtu.be/vIMoAzqtBu0

References:

Victor, “The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and  Malnutrition.” 

Flannery, Adkins, and Cook, “Unpeeling the Evidence for the Banana Bag: Evidence-Based  Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in  the ICU.” 

Torvik, Lindboe, and Rogde, “Brain Lesions in Alcoholics. A Neuropathological Study with Clinical  Correlations.” 

Greenwood, Love, and Pratt, “Kinetics of Thiamine Transport across the Blood-Brain Barrier in the Rat.” 

Thomson et al., “The Royal College of Physicians Report on Alcohol: Guidelines for Managing Wernicke’s  Encephalopathy in the Accident and Emergency Department.” 

Palmiere and Augsburger, “The Postmortem Diagnosis of Alcoholic Ketoacidosis.” 

Miller, Heinig, and Waterhouse, “Treatment of Alcoholic Acidosis: The Role of Dextrose and  Phosphorus.”