When faced with illness, is infusion therapy really the wisest choice?

Author: Liu Shuang, attending physician at Peking Union Medical College Hospital

Ma Shicheng, attending physician at Peking Union Medical College Hospital

Reviewer: Zhu Huadong, attending physician at Peking Union Medical College Hospital

"Doctor, I have had to have intravenous drips whenever I have a cold since I was a child. Why don't you give me an IV?"

"Doctor, I want some fluids to get better faster?"

"My elderly family member is weak and doesn't want to eat. Can you give him some albumin to supplement his nutrition?"

I often hear these words in the outpatient clinic. So, the question is, is intravenous infusion really that good? Why do doctors always say that it is better to take medicine instead of injections, or to have injections instead of intravenous infusions?

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First, there are disadvantages of intravenous infusion

1. Phlebitis. Phlebitis is a strip of red lines along the veins. The local area may feel redness, swelling, burning, and pain. If not treated in time or the blood vessel conditions are poor, the progression of phlebitis may cause skin ulcers or even thrombosis, which is life-threatening. To prevent phlebitis, you must first understand its mechanism of occurrence. To infuse, there must first be a needle in the blood vessel. Whether it is a traditional steel needle or a current indwelling needle, it may cause phlebitis, and the longer the needle is in the blood vessel, the higher the probability of phlebitis. In addition to the needle, the pH, osmotic pressure, concentration of the drug, the effect of the drug itself, and the particles in the liquid may irritate the blood vessels and cause phlebitis. Therefore, the best way to prevent phlebitis is not to infuse.

2. Infusion reaction. Another disadvantage of infusion is infusion reaction. There are inevitably some impurities in the intravenous fluid. After these things are injected into the body, skin redness and itching, breathing difficulties or breath holding, chills, fever, nausea, vomiting and other manifestations may occur. These symptoms are infusion reactions. So can all the impurities in the liquid be eliminated? In fact, high-temperature sterilization has been carried out during the liquid production process, and our country also has strict limits on impurities in liquids injected into the human body. Therefore, most people will not have infusion reactions during the infusion process, and even if an infusion reaction occurs, the degree is very mild. But our principle is to infuse as little as possible.

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3. Adverse reactions. For the same drug, compared with oral administration and intramuscular injection, the probability of adverse reactions (such as allergies) is higher, faster, and more serious due to the fact that intravenous infusion directly enters the blood.

4. Infection. When infusing, the skin must be punctured, and bacteria on the skin may enter the blood through the needle, causing bacteremia and endangering life. Although the skin around the puncture will be disinfected before puncture to prevent most infections, repeated long-term use of the same indwelling needle will also increase the risk of infection.

5. Leakage. Sometimes the infused fluid will leak into the tissue outside the blood vessels, causing the surrounding skin to turn white, swell, and ache. If it is a highly toxic or vasoactive drug, the drug leaking into the surrounding tissue may cause skin ulceration or even tissue necrosis.

2. Oral administration is no less effective than intravenous infusion

For drugs to take effect, they must go through three steps: absorption, distribution, and metabolism, and then act on the corresponding target. Infusion injects the drug directly into the blood, and the absorption part is fast, but it does not mean that the effect of infusion is better than oral administration. Oral and infusion are two ways of taking medicine. There is no absolute good or bad, only whether it is suitable or not. For example, moxifloxacin is well absorbed orally, with a bioavailability of up to 90%, which is no worse than the effect of infusion; another example is aluminum phosphate gel, which can form a protective film to protect the gastric mucosa after oral administration, and can only take effect through oral administration. Therefore, oral administration is completely no worse than infusion, and don't let anxiety get rid of your reason.

3. In terms of nutrition enhancement, enteral nutrition is more effective than parenteral nutrition

Even if the same nutrients are used, enteral nutrition is better than parenteral nutrition. Why? Because enteral nutrition preserves the function of the intestine, maintains the integrity of the intestinal mucosal structure and function, prevents intestinal mucosal atrophy, stimulates the secretion of digestive enzymes, promotes gastrointestinal motility, and reduces the occurrence of infection. Therefore, the effect of enteral nutrition is stronger than that of parenteral nutrition.

4. The body's immunity depends on itself, not just on albumin infusion.

First, it is immunoglobulins, not albumin, that are involved in the human immune response; secondly, the main function of albumin in the human body is to transport and maintain colloidal osmotic pressure; finally, albumin is hydrolyzed into amino acids after entering the human body, and then synthesized into other proteins. In addition, the types of amino acids contained in albumin are not comprehensive, and the nutritional value is very limited. It should be noted that albumin transfusion may cause pyrogenic reactions such as chills, fever, and convulsions.

5. When is infusion necessary?

1. Oral administration is not allowed. If patients need to fast and abstain from water due to gastrointestinal bleeding, early stage of acute pancreatitis, surgery, etc., they need to be supplemented by infusion. If patients are severely dehydrated and vomit and cannot eat, intravenous rehydration can be used to stop vomiting. However, oral administration can be resumed as soon as the condition improves.

2. The patient is in a critical condition. For example, in severe infection or shock, intravenous access must be established immediately for rescue. Saving lives is far more important than the side effects of infusion.

3. The drugs used do not have oral preparations. For example, some broad-spectrum antibiotics, vasoactive drugs, and some cardiotonic drugs can only be administered through intravenous infusion. In this case, it is necessary to fully balance the pros and cons before choosing the appropriate treatment method.

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Infusion can inject drugs directly into blood vessels, but it is neither perfect nor omnipotent. Doctors will choose the appropriate method of administration based on the patient's condition and fully balance the pros and cons.