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((Short description|Bag of IV fluids containing vitamins and minerals))
((Refimprove|article|date=November 2008))

A '''banana bag''' (or '''rally pack''') is a bag of [[IV fluid]]s containing [[vitamins]] and [[minerals]]. The bags typically contain [[thiamine]], [[folic acid]], and [[magnesium sulfate]], and are usually used to correct [[Illnesses related to poor nutrition#Deficiencies|nutritional deficiencies]] or [[chemical imbalance]]s in the human body. The solution has a yellow color, hence the term "banana bag".<ref name=PPMHP /> 

== Composition ==

The typical composition of a banana bag is 1&nbsp;liter of [[normal saline]] ([[sodium chloride]] 0.9%) with:<ref name=pmid27002274/>

* [[Thiamine]] 100&nbsp;mg
* [[Folic acid]] 1&nbsp;mg
* [[Multivitamin]] for infusion (MVI), 1 ampule
* [[Magnesium sulfate]] 3&nbsp;g

The solution is typically infused over four to eight hours or as per physician's orders.((cn|date=September 2022))<!-- source states 24, either find one that says 4~8 or just change it --> The yellow color comes from the riboflavin in the MVI and the folic acid.<ref name=pmid27002274/> (The conventional composition is not optimal based on current evidence; see the Flannery et al. (2016) citation.<ref name=pmid27002274/>)

== Uses ==

Banana bags are often prescribed for [[alcoholic]]s. Chronic alcoholism can lead to significant lack of thiamine, potentially causing [[Wernicke–Korsakoff syndrome]]. Chronic alcoholics can also suffer significant whole-body magnesium deficiencies.<ref name=PPMHP>((cite book|title=Principles of Psychopharmacology for Mental Health Professionals|author1=Jeffrey E Kelsey |author2=D Jeffrey Newport |author3=Charles B Nemeroff  |name-list-style=amp |chapter=Alcohol Use Disorders|pages=196–197|publisher=Wiley-Interscience|year=2006|isbn= 978-0-471-79462-2))</ref><ref>((cite book|title=Introduction to Emergency Medicine|editor1=Elizabeth Mitchell |editor2=Ron Medzon |publisher=Lippincott Williams & Wilkins|year=2005|isbn= 978-0-7817-3200-0|chapter=Acute and Chronic Alcohol Intoxication|author1=Merle A. Carter  |author2=Edward Bernstein |name-list-style=amp |page=272))</ref> 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&nbsp;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.<ref name=pmid27002274>((cite journal |last1=Flannery |first1=Alexander |last2=Adkins |first2=David |last3=Cook |first3=Aaron |title=Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU |journal=Critical Care Medicine |volume=44 |issue=8 |pages=1545–1552 |doi=10.1097/CCM.0000000000001659 |pmid=27002274 |year=2016 |s2cid=22431890 |url=https://www.jvsmedicscorner.com/ICU-Miscellaneous_files/Evidence-Based%20Recommendations%20for%20the%20Management%20of%20Alcohol-Associated%20Vitamin%20and%20Electrolyte%20Deficiencies%20in%20the%20ICU.pdf))</ref> Vitamin C is proposed to be added based on the prevalence of low blood levels among alcoholics, but its therapeutic usefulness is undefined.<ref name="pmid31077227">((cite journal |last1=Marik |first1=PE |last2=Liggett |first2=A |title=Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders. |journal=Critical Care |date=10 May 2019 |volume=23 |issue=1 |pages=165 |doi=10.1186/s13054-019-2435-4 |pmid=31077227|pmc=6511125 |doi-access=free ))</ref>

Banana bags((cn|date=September 2022))<!-- Not specifically the bag, but just says MgSO4! --> are used in the [[intensive care unit]] to correct acute [[magnesium deficiency|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.<ref>((cite journal |last1=Panahi |first1=Y |last2=Mojtahedzadeh |first2=M |last3=Najafi |first3=A |last4=Ghaini |first4=MR |last5=Abdollahi |first5=M |last6=Sharifzadeh |first6=M |last7=Ahmadi |first7=A |last8=Rajaee |first8=SM |last9=Sahebkar |first9=A |title=The role of magnesium sulfate in the intensive care unit. |journal=EXCLI Journal |date=2017 |volume=16 |pages=464–482 |doi=10.17179/excli2017-182 |pmid=28694751|pmc=5491924 ))</ref>

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.<ref>((cite journal |last1=Pawar |first1=RD |last2=Balaji |first2=L |last3=Grossestreuer |first3=AV |last4=Thompson |first4=G |last5=Holmberg |first5=MJ |last6=Issa |first6=MS |last7=Patel |first7=PV |last8=Kronen |first8=R |last9=Berg |first9=KM |last10=Moskowitz |first10=A |last11=Donnino |first11=MW |title=Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study. |journal=Annals of Internal Medicine |date=February 2022 |volume=175 |issue=2 |pages=191–197 |doi=10.7326/M21-2103 |pmid=34871057 |pmc=9169677))</ref> Using thiamine on [[sepsis|septic]] alcoholics seems to reduce the rate of death.<ref>((cite journal |last1=Hu |first1=C |last2=Wu |first2=T |last3=Ma |first3=S |last4=Huang |first4=W |last5=Xu |first5=Q |last6=Kashani |first6=KB |last7=Hu |first7=B |last8=Li |first8=J |title=Association of Thiamine Use with Outcomes in Patients with Sepsis and Alcohol Use Disorder: An Analysis of the MIMIC-III Database. |journal=Infectious Diseases and Therapy |date=April 2022 |volume=11 |issue=2 |pages=771–786 |doi=10.1007/s40121-022-00603-1 |pmid=35169996 |pmc=8960538))</ref>

== See also ==

* [[Intravenous therapy]]

== References ==
((reflist))

[[Category:Intravenous fluids]]


((pharma-stub))

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