The banana bag is popular in hospitals and is used in patients with alcohol withdrawal and sometimes for patients with prolonged vomiting.
A banana bag contains:
- Thiamine 100 mg,
- Folic acid 1mg,
- Multivitamin,
- Isotonic saline (Normal Saline 1,000 mL)
- +/- 5 percent dextrose.
- +/- Magnesium Sulfate 2g.
The banana bag contains a combination of 100 mg of thiamine, 1 mg of folic acid, and a multivitamin formulation in either normal saline or dextrose in water solution. Sometimes 1-2 g of magnesium is added.
The banana bag doesn’t have enough thiamine to treat most patients who are in alcohol withdrawal. For my alcohol withdrawal patients treated on the medical floor, in addition to the banana bag, I give
Thiamine 500 mg IV piggyback daily for 3 days.
An article in Crit Care Med in 2016 says, “Based on the published literature, for patients with a chronic alcohol use disorder admitted to the ICU with symptoms that may mimic or mask Wernicke’s encephalopathy, we suggest abandoning the banana bag and utilizing the following formula for routine supplementation during the first day of admission: 200-500 mg IV thiamine every 8 hours, 64 mg/kg magnesium sulfate (approximately 4-5 g for most adult patients), and 400-1,000 μg IV folate. If alcoholic ketoacidosis is suspected, dextrose-containing fluids are recommended over normal saline.” Crit Care Med. 2016
References and Further Reading
Crit Care Med. 2016 Aug;44(8):1545-52. Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU. https://www.ncbi.nlm.nih.gov/pubmed/27002274