Guidelines for Vitamin Infusion Therapy
Vitamin infusion therapy should only be used for specific medical conditions with documented deficiencies or clinical indications, not as a general wellness intervention. 1
Medically Indicated Uses for Parenteral Vitamin Therapy
Parenteral nutrition support for patients unable to meet nutritional needs through enteral routes, including those with:
Specific vitamin deficiencies requiring parenteral replacement:
- Vitamin B12 deficiency with neurological involvement: hydroxocobalamin 1 mg intramuscularly on alternate days until improvement, then 1 mg every 2 months for maintenance 2
- Vitamin B12 deficiency without neurological involvement: hydroxocobalamin 1 mg intramuscularly three times weekly for 2 weeks 2
- Thiamine deficiency/Wernicke's encephalopathy: immediate treatment with thiamine 200-300 mg daily and vitamin B complex 2
Administration Guidelines for Parenteral Vitamins
- Whenever possible, water and lipid-soluble vitamins should be added to lipid emulsion or a mixture containing lipids to increase vitamin stability 2
- Vitamins should be administered daily when possible, with lipid-soluble vitamins given simultaneously with lipid emulsions 2
- Vitamin K can be given weekly rather than daily 2
Dosing Guidelines by Patient Population
Preterm Infants
- Vitamin A: 700-1500 IU/kg/day (227-455 μg/kg/day) 2
- Vitamin D: 200-1000 IU/day or 80-400 IU/kg/day 2
- Vitamin E: 2.8-3.5 mg/kg/day (not exceeding 11 mg/day) 2
- Vitamin K: 10 μg/kg/day 2
- Vitamin C: 15-25 mg/kg/day 2
Term Infants to 12 Months
- Vitamin A: 150-300 μg/kg/day or 2300 IU/day 2
- Vitamin D: 400 IU/day or 40-150 IU/kg/day 2
- Vitamin E: 2.8-3.5 mg/kg/day 2
- Vitamin K: 10 μg/kg/day 2
- Vitamin C: 15-25 mg/kg/day 2
Children and Adolescents (1-18 years)
- Vitamin A: 150 μg/day 2
- Vitamin D: 400-600 IU/day 2
- Vitamin E: 11 mg/day 2
- Vitamin K: 200 μg/day 2
- Vitamin C: 80 mg/day 2
Adults with Specific Deficiencies
- Vitamin A deficiency: 10,000-25,000 IU oral vitamin A daily for 1-2 weeks 2
- Vitamin E deficiency: oral vitamin E 100-400 IU daily 2
- Vitamin K deficiency: 1-2 mg oral vitamin K daily 2
Monitoring Guidelines
- Routine monitoring of vitamin concentrations (except vitamin D) is not generally recommended unless clinically indicated 2
- For patients on long-term parenteral nutrition (weeks), monitoring may be needed based on clinical indications 2
- Vitamin D levels should be monitored periodically in patients receiving long-term parenteral nutrition 2
- When assessing vitamin E status, adjustment should be made for serum lipids (use ratio of serum vitamin E/total lipids) 2
Important Precautions
- Always check for vitamin B12 deficiency before initiating folic acid treatment to avoid precipitation of subacute combined degeneration of the spinal cord 2
- When supplementing zinc and copper, maintain a ratio of 8-15 mg zinc to 1 mg copper, as each affects the absorption of the other 2
- Vitamin A undergoes substantial photo-degradation and adsorptive loss when given with water-soluble vitamins; delivery may be less than 40% of intended dose 2
- High-dose vitamin E supplementation can exacerbate vitamin K deficiency and affect blood coagulation 2
- Vitamin infusions for non-medical purposes (e.g., "boosting immunity" or "increasing energy") lack high-quality evidence supporting their use 1, 3
- Intravenous vitamin preparations that are prescription-only medicines should only be supplied and administered by appropriately qualified healthcare professionals 1
Preparation and Storage
- For children below 11 years, the contents of one vial of multivitamin preparation can be dissolved in 10 ml of appropriate solution 4
- Children weighing less than 10 kg should receive 1 ml of dissolved vitamin mixture per kg body weight per day 4
- Vitamin C solutions (1.5 g per 50 mL of 0.9% saline and 2.5 g per 50 mL of D5W) remain stable for up to 96 hours and do not need protection from light 5