Title of Invention	A FLUID FORMULATION FOR INTRAVENOUS INFUSION TREATMENT
Abstract	The fluid formulation composed is needed in the treatment needing resuscitation of the patient in various clinical conditions. It consists 1. Energy substrate in the form of Dextrose 2. The active catalyst in the form of soluble (Bovine-Human) Insulin 3. The electrolytes in the form of K, Ca 4. KC1, Calcium gluconate and other electrolytes With an option of containing additional like 5. Vitamins 6. Heparin 7. Amino acids 8. Lipids The author believes all these are required regularly in the management of patients by way of facilitating the homeostatic mechanism of the body to regulate the balance disturbed. Though the complex homeostatic mechanism of the body has enormous capability to rectify all the resultant adverse changes of stress, shock and various critical conditions can still get vitiated further if not handled with proper understanding.

Title of Invention

A FLUID FORMULATION FOR INTRAVENOUS INFUSION TREATMENT

Abstract

The fluid formulation composed is needed in the treatment needing resuscitation of the patient in various clinical conditions. It consists 1. Energy substrate in the form of Dextrose 2. The active catalyst in the form of soluble (Bovine-Human) Insulin 3. The electrolytes in the form of K, Ca 4. KC1, Calcium gluconate and other electrolytes With an option of containing additional like 5. Vitamins 6. Heparin 7. Amino acids 8. Lipids The author believes all these are required regularly in the management of patients by way of facilitating the homeostatic mechanism of the body to regulate the balance disturbed. Though the complex homeostatic mechanism of the body has enormous capability to rectify all the resultant adverse changes of stress, shock and various critical conditions can still get vitiated further if not handled with proper understanding.

Full Text	The fluid formulation composed is needed in the treatment needing resuscitation of clinical conditions. It consists 1. Energy substrate in the form of Dextrose 2. The active catalyst in the form of soluble (Bovine-Human) Insulin 3. The electrolytes in the form of K, Ca 4. KC1, Calcium gluconate and other electrolytes With an option of containing additional like 5. Vitamins 6. Heparin 7. Amino acids 8. Lipids The author believes all these are required regularly in the management of patients by way of facilitating the homeostatic mechanism of the body to regulate the balance disturbed. Though the complex homeostatic mechanism of the body has enormous capability to rectify all the resultant adverse changes of Stress Shock and various critical conditions can still get vitiated further if not handled with proper understanding. The commonly used present remedy needs to be improved based on the authors all along advocated and practiced concept. More so now as more and more supportive informations are available to provide supportive firmer background to the concept. With the help of brief understandable abreviative denotative informations indicating their use, the various types of solutions can be made available. These will enable larger section of the profession with reasonable understanding of the clinical condition as well as the composition and their use will enable them to use these fluids with a large scope to gain better outcomes. Background Patients receive intravenous fluids in the form of nutrients minerals vitamins antibiotics and other life saving drugs in a number of clinical conditions. It is also proved to be reliable and effective means of providing them for reliable, and predictable effects with minimum of inconvenience to the patients. This may be the only means of treatment feasible on many occasions as a measure of resuscitative procedure to revive the patients from critically ill state to a state of survival and back to normal life. The presently available fluids are inadequate in all aspect except the water content of the need of the patient. They are hypotonic in effect even though they are isotonic when used in critical conditions. The author has been feeling, the needs of the patients under such circumstances by the presently infused fluids are hardly met, thus putting the patient in a state of disadvantage to face the clinical condition and to recover back to normal. Preamble With the development of science the desires and expectations of the patients keep on improving in terms of better results, at less cost, effort, and loss of working time, in previously treatable cases and revival and prolongation of life when earlier they were not possible. Much has been achieved in these directions in medical science. As part of the treatment even till today on quite few occasions the existing intravenous infusions consisting mainly water dextrose electrolytes. Subsequently the same route has been utilised for administration of antibiotics, proteins and lipid solutions along with many other soluble materials needed in particular instances. The commonly used solutions are in packing of 500 ml 1. 5% Dextrose 2. 0. 9% NaCl solutions 3. Ringers lactate solutions etc. All these have been used, as basic fluids when patient needed administration of therapeutic fluids and other ingredients. In certain special circumstances, fluids like 1. 10% Dextrose 2. 10% Dextrose in normal saline (0.9%) 3. 20-25% Dextrose 4. Dialysis fluids 5. Blood and blood components 6. Low Molecular Dextrans 7. Mannitol and 8. Bulk form antibiotics With the further development of science, it has been evident that, we have been providing insufficient and inadequate calories, from limited sources of these needed calories by way of energy substrates, electrolytes, vitamins and other needed elements. This late awareness of inadequate knowledge of stress, shock, and critical conditions has resulted in many centres to put up added attention and efforts to study and evaluate the effects. This has lead to more specific and other related information available. All these stress on the need to restore homeostasis towards normal, by restoring tissue perfusion and acid base balance towards normal. This will enable to improve the condition, to revive and restore normalcy, as has been stressed all along by the author. The presently available fluids are 1. Unable to meet the calorie need of the patient. These needed calories require to originate from dextrose, amino acids, and lipids. 2. Unable to meet the electrolytes required by the patient, in terms of variety and quantity, as well as 3. Unable to utilise, the energy substrate and electrolytes available, in view of high levels of catacholamines. All these result in a state of catabolism and their consequential effects on the body is aptly described as a state of auto-cannibalism. We need to stop or prevent this from happening. This emphasizes the need of infusions providing the needs of the body in terms of, calorie, electrolytes, substrates, vitamins and other essentials to enable and utilise to treat, improve, revive and restore normalcy. Prophylactic measures on this line of approach in expected situations like major operative procedures should enable one to minimise the risks of the procedure considerably. The fluids needed are broadly categorised for use to suit the various situations. The following abbreviations are used to denote the fluid and their possible place of use. These abbreviations are denoted as G-Gangal, N- Non-diabetic, D-Diabetic E-Electrolytes, H-Heparin, V-Vitamins, I-Insulin, PL-Plain/Soluble bovine potentially equivalent Human insulin preferred. Dext-Dextrose. A.E - Actual electrolytes to replace the Extra cellular electrolytes, A.M - Actual electrolytes needed in Maintenance solutions as are presently available, to be taken as With these improved formulations, it has been possible to meet die largely needed requirements under various types of critical clinical conditions, as can be rationalised today. One should appreciate, though these formulations may be able to meet the needed requirements, will enable us to standardise the approach, and give scope in a better way to improve further the formulations, thus enabling us to gain still further occasion to improve, the formulation to attain better results within scope of the appended claims in formulations. We may also gain better and larger scope of their use in various other conditions, like omiting Heparin in where ever it is felt better to omit. The formulations consists of the following and other ingredients mentioned in the above clarifications and in the text. 1. Water: The main and die essential ingredient of die body, acting as media /vehicle to mention die circulation of nutrients, essentials and to remove wastes from die body .It helps to mentain physiological state in and around die body congenial to sustain normal life. Water is a natural component of die body, and is also die main vehicle / media dirough which die body's circulation is mentained. This makes it possible die essentials of life and function are made available from die body to die cell level and receives back the wastes from die cell level to die organ to be eliminated out of die body. The volume of die water needed by die body varies widi the functional level, the problems faced and die environment. Accordingly the volume of fluid needed to be infused -to balance die need and die output and also to mentain effective circulation - are required into consideration to asses. 2. Dextrose: A major source of energy out of all odier essential energy substrates. A must for living and sustaining life. Dextrose in die form of 5% as an isotonic soludon has been the main stay of intravenous infusion in all forms of condidons where infusion forms die treatment as well as a resuscitative measure. In states of stress, shock, and cridcal conditions, diis isotonic will have an effect of hypotonic solution. Thus, likely to cause enormous harmful effects. Here it is used in hypertonic form to enable it to provide needed higher calories along with higher amounts of insulin, and also avoid effects of hypotonic solutions. Normally it forms the main source of energy to be supplemented by aminoacids, and emulsified fat soludons. This helps to meet die needs of essential aminoacids, and also fats, along widi enables to prevent die bad and rebound effects of prolonged use of carbohydrates alone. This results in accumulation of acidic components and triggering of catacholamine response, -indeed an unwanted response at an odd occasion to result in further effects to an already critical condition. Here I use 10%, 15%, 20%, and along widi insulin, electrolytes, vitamins, and Heparin. I need to provide higher amount of dextrose to meet die high levels of metabolism. This is likely to avoid autocannibalism and its consequent outcome of survival. 3. Na: Sodium chloride forms a major and a main electrolyte. It is also called die 2end pump to mentain the circulation. Sodium Chloride : 0.9% Nacl is an isotonic soludon, commonly used as such or in combination widi Dextrose solutions. It is one of die main electrolyte, die body needs. It is mainly an extra cellular electrolyte widi a small intracellular component, having a reciprocal gradient relation widi K ion responding to any effective agents. The intake and output needs to be balanced. It is commonly used as such or along widi 5% or 10% Dextrose solutions. The body contains a-large amount, Hearing around 5000 mEq of Na, widi an average need of, 80 - 100, mEq / Day. This is mostly lost in die urine. In die normal individual, on one hand diere is a large reserve, on die odier hand diere is an excellent mechanism to conserve by normal functioning kidney. This can result in bringing urinary loss of Na to zero, in die absence of intake of Na. Still large fluctuations do occur with resultant serious problems. Hence it needs to be managed properly to retain homeostasis 4. Ca; Calcium similarly forms a major cation component of the body, having role to play in homeostasis, membrane potentials, inter cellular junctions and cell functions. Calcium: Calcium is a major component of the body forming around 2% of the bodyweight 99% of it is in the form of bone. Part of it is constantly changing to contribute to the extra-cellular component. This is under die influence of simple ion exchange. Paradiarmone, Vit D, Corticosteroids cause disturbances in Calcium content. Any, variations in die extra-cellular component affects die homeostasis, which in turn results in deranged cellular functions. Average Indian diet may contain as low as 0.2 gins as against die daily need of 0.5 to 0.6 gm on an average. The needs are higher in later terms of pregnancy and lactation - dius needing up to around 1 gram of Calcium a day. Intracellular Ca regulates cell metabolism, ifs function and inter junctional permeability. Willi normally functioning kidneys, 99% of the Ca gets reabsorbed from die tubules: Urinary Ca excretion increases with hypercalcemia of any cause, metabolic acidosis and use of cortisones. . Ca is an important component of the cell membrane and competes widi Na. Raised Ca, in blood increases the threshold for contraction and low Ca leads to tetany. Ca also plays role in coagulation of blood, coupling mechanism between excitation and contraction of muscles, and secretary mechanism of Insulin. 5. K: Potassium mainly an intracellular electrolyte having a significant role to play in cell membrane potentials and cell functions. Potassium chloride: Kcl solution is available for intravenous use, needs to be diluted considerably to use. Normally-diere is about 3500 mEq of Potassium in the body, of which 98%is intracellular and hardly 2% is in extra-cellular compartment. This small part of the Potassium plays a major role in the functioning of the smooth, skeletal, and cardiac muscles, as a result any variations that occur in its level can certainly cause considerable problems. Seventy-five percent of the Potassium is found in the skeletal muscles. Normally on an average die body needs around 50 to 80 mEq of Potassium per day. The main route of loss is through normally functioning kidney. The minimum that is lost dirough urine could be 20 mEq even in the absence of Potassium intake. In view of the high quantity of Potassium is in intracellular compartment any injury to die organs is bound to increase die extra-cellular Potassium. It is to a certain extent dependent on die level of Sodium, oUier hormones and diuretics. Its movements / transfer is related to metabolism. There are occasions where intracellular Potassium deficiency may be present aldiough die plasma level is normal, Such situations need careful evaluation dian casual look. 6. Other electrolytes: As are included in the Arolyte solutions are also essential to die body function and are required to be ment7ained in balance. All diese have been used in clinical application. 7. Insulin: Insulin is an essential hormone required in die process of metabolism of carbohydrates, proteins, and fats. Involving almost all organs in the body. 8, Heparin: It is a naturally occurring substance, not occurring in blood to a measurable extent, prevents blood coagulation. It plays significant role in cases of trauma induced on any account. Blood coagulation is essentially a series of enzymatic reactions involving a number of plasma proteins. Many of these are present only in traces. Within an intact healthy circulatory system these enzymes, for the most part, are in an inactive form, when the blood is shed on wetable surfaces, a series of autocatalytic enzymatic reaction is initiated - this is a process of - more complex and confused in results, interpretations, and opinions. To make order out of such chaos an international system of numbering has been introduced for the identification of those factors accepted by majority of authorities in the field. Tissue extracts are also known to accelerate the clotting of whole blood. This tissue extract known as thromboplastin-requires lipid and protein constituents for full activity. When this action is initiated by blood constituents is called intrinsic, when initiated by tissue extract thromsoplastin is called extrinsic source. Though they start differently to begin with final process of coagulation is common to both forms of initiations. Heparin - is not present in normal blood in measurable amount. It does not prevent blood coagulation. When added as a therapeutic agent. It acts at a number of sites along the chain of reaction. Its probable initial, action is to prevent die development of Uiromboplastin activity. Heparin has immediate action on die coagulation system. It is a naturally occurring sulfonated polysaccharide with strong anticoagulant action. It is rapidly inactivated and removed from die circulation. It is difficult to maintain dierapeudc level in die blood while avoiding die danger from bleeding. Here it is used to prevent likely initiation of early thrombo - embolic phenominon. In die present situation medical science is not as exact as madiematics and it may not be so forever. Life science is so complex, and every effort, eidier to understand, evaluate, or treat, involves, time, money, risk and need of invasive procedures, widi added risks. 9. Vitamins: Fat mid water-soluble vitamins are organic compounds, forming as components or cofactors for enzymes concerned widi metabolism of carbohydrates, fats, and proteins. Most of the vitamins are acquired from dietary sources. Very few to a small extent are synthesised in die body. B. Group vitamins act, as essential co-enzymes required as intermediary in die metabolism. Dietary vitamins need to be converted to its co-enzyme form in order to be useful. It is also noted diese vitamins are interdependent on dieir metabolism and utilisation. In the absence of sources of supply, use of various drugs affecting their metabolism, diat too under circumstances of raised metabolic state, diere, does occur an occasion to provide diese needed Vitamins in the form of intravenous administration. These Vitamins are classified, as Fat Soluble Vitamins, - A D.E.K - are stored in die body. Water Soluble Vitamins, - B Group & C are not stored and any excess is rapidly excreted in die urine. They arc not toxic. And tend not to cause interaction widi drugs. This likely Vitamin deficiency occurring during total parenteral nutrition, and parenteral therapy, are attended by providing as follows. Vitamin A-Daily dose of around 10,000 to 20,000 I.U in the form of made as water soluble could be essential to mentain the integrity of the epithelial cells, synthesis of glucocortcoids, cholesterol, and for somatic growth, upper respiratory tract epithelium. Vitamin D- To facilitate interdepartmental metabolism between vitamins, and to .mentain Ca. Homeostasis. It is quite important in the acute conditions-like, mobilisation of insulin, coupling mechanism of excitation and contraction mechanism of muscles. These have some relevance to diabetes normal organ function and essential hypertension. Vitamin Bi - are mainly concerned with Carbohydrate metabolism. IV / IM administration of large doses may cause anaphylactic shock and interfere with action of other B vitamins. B3 - Nicotinic acid is required in Protein metabolism, necessary in respiration B6 - Indirectly affects carbohydrate metabolism, directly the catacholamines, gamma-amin obutyricacid,etc, B7 - is involved in fundamental biological reactions. B12 - is necessary in mentainance of function of the nervous system and conduction mechanism. C - Concerned with cellular respiration / oxidation-reduction reactions, and Formation of collagen, intercellular matrix development of cartilage, wound healing, carbohydrate metabolism. E - Alpha Tocopheryl Acetate is said to be essential to maintain integrity and stability of biological membranes, normal structure and function of the nervous system and is mostly used on an empirical base. It is known to be antioxydent. l)Choline Chloride is akin to B group of Vitamins but synthesised in the human body. It plays an important role as a structural component of tissues and in biological methilation reactions. It is a precursor of acetylcholine, and some hormones. Its biogenesis is universal in nature. It helps to spare aminoacids in protein synthesis. It prevents fatty infiltration of liver - a hypertropic agent, average estimated consumption appears to be around 500 to 900 mgm/a day. Di: Methionine - is sulphur containing aminoacid and inseparable dietary component. Methionine has lipotropic action, and is considered as useful adjutant of treatment of liver diseases. It enhances synthesis of glutathione, necessary for detoxification of toxic metabolites of paracetamol. Average needs are around 200 to 500 mgm. Inosital - occurs in nearly all plant, and animal cell, suggesting it to be an essential cell constituent. It is found to be a constituent of an amylase enzyme system. To a certain extent it is syntiiesised by die intestinal flora. It possesses weak lipotropic activity prevents fatty liver. It could be beneficial in diabetic neuropathy. Stress, trauma, shock, critical conditions, sepsis, surgery increase the catabolic rate. This increased catabolism is a self-destructive response to the above stated illnesses, It is termed as auto cannibalism needing everyone* s attention to prevent it occurring. The developments in medical sciences appear to have been based mostly on die outcome of interested individuals efforts. There has been no systematic developmental effort to study life science, as it stands smaller priority, in the Government and personal levels. Hence allocation of funds in comparison with defence, industry etc are very meagre. In such circumstances the evaluations are difficult. Presently adopted methods of treatment are largely based on the individual knowledge, and capability to evaluate the condition he is handling. Thus giving large scope for variations and the resultant outcomes. On the background of the experience in the experimental surgery in developing open heart surgery mid handling critically ill patients, major trauma patients, the concept adopted by me and resultant comparatively better outcomes led me to continue the work and peruse to gain further information on die line. I continued to try the concept in conditions where die senior colleagues could not expect any hope (widi appreciable good results), convinced me, die approach stands better scope in die present situation. Widi more and more information now available, die scope of use of my concept has enlarged and die results have proved its wordiiness to be perused. It needs fair variations widi die fundamental concept remaining to be die backbone in all its variant approach in different clinical pictures. I feel stress, trauma, shock critical conditions, surgery infections cause a state of disturbed neuro hormonal response resulting in changed hormonal catachalamine levels, homeostatic conditions, altered level of defence mechanism and metabolism. All needs to be attended, to provide proper physiological response to restore normalcy and recovery. This needs my approach to be well-balanced, gradual, predictable and reasonable, to gain near natural normal life, witiiout die need of prolonged Uicrapy assisted sustenance of life. 1) I also feel -every individual is potentially diabetic, hypertensive-more so under states of stress and allied situations is now corroborated by quite a few, 2) There is a raised metabolism under states of stress & critical condition leading to autocannibalism- a worst situation - leading to multiple organ dysfunction syndromes. As a preventive measure to minimise such occurrences, I use diese fluids, in 1) Stress - Primary Hypertension Angina pectoris. 2) Shock, a) Multiple traumatic injuries. b) Perforative peritonitis c) Pancreatitis d) Major operative procedures e) Major vascular surgeries. Like dirombo-end artercctomics Mesocaval anatomises in portal hypertension etc. 3) Cirrhosis of liver 4) Scorpion sl/ings, Snake bites 5) Bacterial resistant infections - Septic shock 6) In conditions ? Coronary Artery diseases ? Myocardial Infarcts ? Following Cardio-Vascular Surgeries 7) Adult Respiratory distress Syndromes. 8) Multi-organ Dysfunction Syndrome 9) Poly - Cystic Kidney 10) Alzheimer's disease & many odier clinical conditions associated widi critical situations. These fluids by tiieir concurrant use in conditions like HIV and Australian Antigen Virus infestation may provide better results by restoring die cell and organ environment, to a near normal level, and assist die defence mechanism of die body they have benificial effects on the cell membrane. These situations may be occuring in non-diabetic individuals or manifest diabetic individuals. They can be treated accordingly. The fluid formulation composed is needed in the treatment needing resuscitation of clinical conditions. It consists 1. Energy substrate in the form of Dextrose 2. The active catalyst in the form of soluble (Bovine-Human) Insulin 3. The electrolytes in the form of K, Ca 4. KC1, Calcium gluconate and other electrolytes With an option of containing additional like 5. Vitamins 6. Heparin 7. Amino acids 8. Lipids The author believes all these are required regularly in the management of patients by way of facilitating the homeostatic mechanism of the body to regulate the balance disturbed. Though the complex homeostatic mechanism of the body has enormous capability to rectify all the resultant adverse changes of Stress Shock and various critical conditions can still get vitiated further if not handled with proper understanding. The commonly used present remedy needs to be improved based on the authors all along advocated and practiced concept. More so now as more and more supportive informations are available to provide supportive firmer background to the concept. With the help of brief understandable abreviative denotative informations indicating their use, the various types of solutions can be made available. These will enable larger section of the profession with reasonable understanding of the clinical condition as well as the composition and their use will enable them to use these fluids with a large scope to gain better outcomes. Background Patients receive intravenous fluids in the form of nutrients minerals vitamins antibiotics and other life saving drugs in a number of clinical conditions. It is also proved to be reliable and effective means of providing them for reliable, and predictable effects with minimum of inconvenience to the patients. This may be the only means of treatment feasible on many occasions as a measure of resuscitative procedure to revive the patients from critically ill state to a state of survival and back to normal life. The presently available fluids are inadequate in all aspect except the water content of the need of the patient. They are hypotonic in effect even though they are isotonic when used in critical conditions. The author has been feeling, the needs of the patients under such circumstances by the presently infused fluids are hardly met, thus putting the patient in a state of disadvantage to face the clinical condition and to recover back to normal. Preamble With the development of science the desires and expectations of the patients keep on improving in terms of better results, at less cost, effort, and loss of working time, in previously treatable cases and revival and prolongation of life when earlier they were not possible. Much has been achieved in these directions in medical science. As part of the treatment even till today on quite few occasions the existing intravenous infusions consisting mainly water dextrose electrolytes. Subsequently the same route has been utilised for administration of antibiotics, proteins and lipid solutions along with many other soluble materials needed in particular instances. The commonly used solutions are in packing of 500 ml 1. 5% Dextrose 2. 0. 9% NaCl solutions 3. Ringers lactate solutions etc. All these have been used, as basic fluids when patient needed administration of therapeutic fluids and other ingredients. In certain special circumstances, fluids like 1. 10% Dextrose 2. 10% Dextrose in normal saline (0.9%) 3. 20-25% Dextrose 4. Dialysis fluids 5. Blood and blood components 6. Low Molecular Dextrans 7. Mannitol and 8. Bulk form antibiotics With the further development of science, it has been evident that, we have been providing insufficient and inadequate calories, from limited sources of these needed calories by way of energy substrates, electrolytes, vitamins and other needed elements. This late awareness of inadequate knowledge of stress, shock, and critical conditions has resulted in many centres to put up added attention and efforts to study and evaluate the effects. This has lead to more specific and other related information available. All these stress on the need to restore homeostasis towards normal, by restoring tissue perfusion and acid base balance towards normal. This will enable to improve the condition, to revive and restore normalcy, as has been stressed all along by the author. The presently available fluids are 1. Unable to meet the calorie need of the patient. These needed calories require to originate from dextrose, amino acids, and lipids. 2. Unable to meet the electrolytes required by the patient, in terms of variety and quantity, as well as 3. Unable to utilise, the energy substrate and electrolytes available, in view of high levels of catacholamines. All these result in a state of catabolism and their consequential effects on the body is aptly described as a state of auto-cannibalism. We need to stop or prevent this from happening. This emphasizes the need of infusions providing the needs of the body in terms of, calorie, electrolytes, substrates, vitamins and other essentials to enable and utilise to treat, improve, revive and restore normalcy. Prophylactic measures on this line of approach in expected situations like major operative procedures should enable one to minimise the risks of the procedure considerably. The fluids needed are broadly categorised for use to suit the various situations. The following abbreviations are used to denote the fluid and their possible place of use. These abbreviations are denoted as G-Gangal, N- Non-diabetic, D-Diabetic E-Electrolytes, H-Heparin, V-Vitamins, I-Insulin, PL-Plain/Soluble bovine potentially equivalent Human insulin preferred. Dext-Dextrose. A.E - Actual electrolytes to replace the Extra cellular electrolytes, A.M - Actual electrolytes needed in Maintenance solutions as are presently available, to be taken as With these improved formulations, it has been possible to meet die largely needed requirements under various types of critical clinical conditions, as can be rationalised today. One should appreciate, though these formulations may be able to meet the needed requirements, will enable us to standardise the approach, and give scope in a better way to improve further the formulations, thus enabling us to gain still further occasion to improve, the formulation to attain better results within scope of the appended claims in formulations. We may also gain better and larger scope of their use in various other conditions, like omiting Heparin in where ever it is felt better to omit. The formulations consists of the following and other ingredients mentioned in the above clarifications and in the text. 1. Water: The main and die essential ingredient of die body, acting as media /vehicle to mention die circulation of nutrients, essentials and to remove wastes from die body .It helps to mentain physiological state in and around die body congenial to sustain normal life. Water is a natural component of die body, and is also die main vehicle / media dirough which die body's circulation is mentained. This makes it possible die essentials of life and function are made available from die body to die cell level and receives back the wastes from die cell level to die organ to be eliminated out of die body. The volume of die water needed by die body varies widi the functional level, the problems faced and die environment. Accordingly the volume of fluid needed to be infused -to balance die need and die output and also to mentain effective circulation - are required into consideration to asses. 2. Dextrose: A major source of energy out of all odier essential energy substrates. A must for living and sustaining life. Dextrose in die form of 5% as an isotonic soludon has been the main stay of intravenous infusion in all forms of condidons where infusion forms die treatment as well as a resuscitative measure. In states of stress, shock, and cridcal conditions, diis isotonic will have an effect of hypotonic solution. Thus, likely to cause enormous harmful effects. Here it is used in hypertonic form to enable it to provide needed higher calories along with higher amounts of insulin, and also avoid effects of hypotonic solutions. Normally it forms the main source of energy to be supplemented by aminoacids, and emulsified fat soludons. This helps to meet die needs of essential aminoacids, and also fats, along widi enables to prevent die bad and rebound effects of prolonged use of carbohydrates alone. This results in accumulation of acidic components and triggering of catacholamine response, -indeed an unwanted response at an odd occasion to result in further effects to an already critical condition. Here I use 10%, 15%, 20%, and along widi insulin, electrolytes, vitamins, and Heparin. I need to provide higher amount of dextrose to meet die high levels of metabolism. This is likely to avoid autocannibalism and its consequent outcome of survival. 3. Na: Sodium chloride forms a major and a main electrolyte. It is also called die 2end pump to mentain the circulation. Sodium Chloride : 0.9% Nacl is an isotonic soludon, commonly used as such or in combination widi Dextrose solutions. It is one of die main electrolyte, die body needs. It is mainly an extra cellular electrolyte widi a small intracellular component, having a reciprocal gradient relation widi K ion responding to any effective agents. The intake and output needs to be balanced. It is commonly used as such or along widi 5% or 10% Dextrose solutions. The body contains a-large amount, Hearing around 5000 mEq of Na, widi an average need of, 80 - 100, mEq / Day. This is mostly lost in die urine. In die normal individual, on one hand diere is a large reserve, on die odier hand diere is an excellent mechanism to conserve by normal functioning kidney. This can result in bringing urinary loss of Na to zero, in die absence of intake of Na. Still large fluctuations do occur with resultant serious problems. Hence it needs to be managed properly to retain homeostasis 4. Ca; Calcium similarly forms a major cation component of the body, having role to play in homeostasis, membrane potentials, inter cellular junctions and cell functions. Calcium: Calcium is a major component of the body forming around 2% of the bodyweight 99% of it is in the form of bone. Part of it is constantly changing to contribute to the extra-cellular component. This is under die influence of simple ion exchange. Paradiarmone, Vit D, Corticosteroids cause disturbances in Calcium content. Any, variations in die extra-cellular component affects die homeostasis, which in turn results in deranged cellular functions. Average Indian diet may contain as low as 0.2 gins as against die daily need of 0.5 to 0.6 gm on an average. The needs are higher in later terms of pregnancy and lactation - dius needing up to around 1 gram of Calcium a day. Intracellular Ca regulates cell metabolism, ifs function and inter junctional permeability. Willi normally functioning kidneys, 99% of the Ca gets reabsorbed from die tubules: Urinary Ca excretion increases with hypercalcemia of any cause, metabolic acidosis and use of cortisones. . Ca is an important component of the cell membrane and competes widi Na. Raised Ca, in blood increases the threshold for contraction and low Ca leads to tetany. Ca also plays role in coagulation of blood, coupling mechanism between excitation and contraction of muscles, and secretary mechanism of Insulin. 5. K: Potassium mainly an intracellular electrolyte having a significant role to play in cell membrane potentials and cell functions. Potassium chloride: Kcl solution is available for intravenous use, needs to be diluted considerably to use. Normally-diere is about 3500 mEq of Potassium in the body, of which 98%is intracellular and hardly 2% is in extra-cellular compartment. This small part of the Potassium plays a major role in the functioning of the smooth, skeletal, and cardiac muscles, as a result any variations that occur in its level can certainly cause considerable problems. Seventy-five percent of the Potassium is found in the skeletal muscles. Normally on an average die body needs around 50 to 80 mEq of Potassium per day. The main route of loss is through normally functioning kidney. The minimum that is lost dirough urine could be 20 mEq even in the absence of Potassium intake. In view of the high quantity of Potassium is in intracellular compartment any injury to die organs is bound to increase die extra-cellular Potassium. It is to a certain extent dependent on die level of Sodium, oUier hormones and diuretics. Its movements / transfer is related to metabolism. There are occasions where intracellular Potassium deficiency may be present aldiough die plasma level is normal, Such situations need careful evaluation dian casual look. 6. Other electrolytes: As are included in the Arolyte solutions are also essential to die body function and are required to be ment7ained in balance. All diese have been used in clinical application. 7. Insulin: Insulin is an essential hormone required in die process of metabolism of carbohydrates, proteins, and fats. Involving almost all organs in the body. 8, Heparin: It is a naturally occurring substance, not occurring in blood to a measurable extent, prevents blood coagulation. It plays significant role in cases of trauma induced on any account. Blood coagulation is essentially a series of enzymatic reactions involving a number of plasma proteins. Many of these are present only in traces. Within an intact healthy circulatory system these enzymes, for the most part, are in an inactive form, when the blood is shed on wetable surfaces, a series of autocatalytic enzymatic reaction is initiated - this is a process of - more complex and confused in results, interpretations, and opinions. To make order out of such chaos an international system of numbering has been introduced for the identification of those factors accepted by majority of authorities in the field. Tissue extracts are also known to accelerate the clotting of whole blood. This tissue extract known as thromboplastin-requires lipid and protein constituents for full activity. When this action is initiated by blood constituents is called intrinsic, when initiated by tissue extract thromsoplastin is called extrinsic source. Though they start differently to begin with final process of coagulation is common to both forms of initiations. Heparin - is not present in normal blood in measurable amount. It does not prevent blood coagulation. When added as a therapeutic agent. It acts at a number of sites along the chain of reaction. Its probable initial, action is to prevent die development of Uiromboplastin activity. Heparin has immediate action on die coagulation system. It is a naturally occurring sulfonated polysaccharide with strong anticoagulant action. It is rapidly inactivated and removed from die circulation. It is difficult to maintain dierapeudc level in die blood while avoiding die danger from bleeding. Here it is used to prevent likely initiation of early thrombo - embolic phenominon. In die present situation medical science is not as exact as madiematics and it may not be so forever. Life science is so complex, and every effort, eidier to understand, evaluate, or treat, involves, time, money, risk and need of invasive procedures, widi added risks. 9. Vitamins: Fat mid water-soluble vitamins are organic compounds, forming as components or cofactors for enzymes concerned widi metabolism of carbohydrates, fats, and proteins. Most of the vitamins are acquired from dietary sources. Very few to a small extent are synthesised in die body. B. Group vitamins act, as essential co-enzymes required as intermediary in die metabolism. Dietary vitamins need to be converted to its co-enzyme form in order to be useful. It is also noted diese vitamins are interdependent on dieir metabolism and utilisation. In the absence of sources of supply, use of various drugs affecting their metabolism, diat too under circumstances of raised metabolic state, diere, does occur an occasion to provide diese needed Vitamins in the form of intravenous administration. These Vitamins are classified, as Fat Soluble Vitamins, - A D.E.K - are stored in die body. Water Soluble Vitamins, - B Group & C are not stored and any excess is rapidly excreted in die urine. They arc not toxic. And tend not to cause interaction widi drugs. This likely Vitamin deficiency occurring during total parenteral nutrition, and parenteral therapy, are attended by providing as follows. Vitamin A-Daily dose of around 10,000 to 20,000 I.U in the form of made as water soluble could be essential to mentain the integrity of the epithelial cells, synthesis of glucocortcoids, cholesterol, and for somatic growth, upper respiratory tract epithelium. Vitamin D- To facilitate interdepartmental metabolism between vitamins, and to .mentain Ca. Homeostasis. It is quite important in the acute conditions-like, mobilisation of insulin, coupling mechanism of excitation and contraction mechanism of muscles. These have some relevance to diabetes normal organ function and essential hypertension. Vitamin Bi - are mainly concerned with Carbohydrate metabolism. IV / IM administration of large doses may cause anaphylactic shock and interfere with action of other B vitamins. B3 - Nicotinic acid is required in Protein metabolism, necessary in respiration B6 - Indirectly affects carbohydrate metabolism, directly the catacholamines, gamma-amin obutyricacid,etc, B7 - is involved in fundamental biological reactions. B12 - is necessary in mentainance of function of the nervous system and conduction mechanism. C - Concerned with cellular respiration / oxidation-reduction reactions, and Formation of collagen, intercellular matrix development of cartilage, wound healing, carbohydrate metabolism. E - Alpha Tocopheryl Acetate is said to be essential to maintain integrity and stability of biological membranes, normal structure and function of the nervous system and is mostly used on an empirical base. It is known to be antioxydent. l)Choline Chloride is akin to B group of Vitamins but synthesised in the human body. It plays an important role as a structural component of tissues and in biological methilation reactions. It is a precursor of acetylcholine, and some hormones. Its biogenesis is universal in nature. It helps to spare aminoacids in protein synthesis. It prevents fatty infiltration of liver - a hypertropic agent, average estimated consumption appears to be around 500 to 900 mgm/a day. Di: Methionine - is sulphur containing aminoacid and inseparable dietary component. Methionine has lipotropic action, and is considered as useful adjutant of treatment of liver diseases. It enhances synthesis of glutathione, necessary for detoxification of toxic metabolites of paracetamol. Average needs are around 200 to 500 mgm. Inosital - occurs in nearly all plant, and animal cell, suggesting it to be an essential cell constituent. It is found to be a constituent of an amylase enzyme system. To a certain extent it is syntiiesised by die intestinal flora. It possesses weak lipotropic activity prevents fatty liver. It could be beneficial in diabetic neuropathy. Stress, trauma, shock, critical conditions, sepsis, surgery increase the catabolic rate. This increased catabolism is a self-destructive response to the above stated illnesses, It is termed as auto cannibalism needing everyone* s attention to prevent it occurring. The developments in medical sciences appear to have been based mostly on die outcome of interested individuals efforts. There has been no systematic developmental effort to study life science, as it stands smaller priority, in the Government and personal levels. Hence allocation of funds in comparison with defence, industry etc are very meagre. In such circumstances the evaluations are difficult. Presently adopted methods of treatment are largely based on the individual knowledge, and capability to evaluate the condition he is handling. Thus giving large scope for variations and the resultant outcomes. On the background of the experience in the experimental surgery in developing open heart surgery mid handling critically ill patients, major trauma patients, the concept adopted by me and resultant comparatively better outcomes led me to continue the work and peruse to gain further information on die line. I continued to try the concept in conditions where die senior colleagues could not expect any hope (widi appreciable good results), convinced me, die approach stands better scope in die present situation. Widi more and more information now available, die scope of use of my concept has enlarged and die results have proved its wordiiness to be perused. It needs fair variations widi die fundamental concept remaining to be die backbone in all its variant approach in different clinical pictures. I feel stress, trauma, shock critical conditions, surgery infections cause a state of disturbed neuro hormonal response resulting in changed hormonal catachalamine levels, homeostatic conditions, altered level of defence mechanism and metabolism. All needs to be attended, to provide proper physiological response to restore normalcy and recovery. This needs my approach to be well-balanced, gradual, predictable and reasonable, to gain near natural normal life, witiiout die need of prolonged Uicrapy assisted sustenance of life. 1) I also feel -every individual is potentially diabetic, hypertensive-more so under states of stress and allied situations is now corroborated by quite a few, 2) There is a raised metabolism under states of stress & critical condition leading to autocannibalism- a worst situation - leading to multiple organ dysfunction syndromes. As a preventive measure to minimise such occurrences, I use diese fluids, in 1) Stress - Primary Hypertension Angina pectoris. 2) Shock, a) Multiple traumatic injuries. b) Perforative peritonitis c) Pancreatitis d) Major operative procedures e) Major vascular surgeries. Like dirombo-end artercctomics Mesocaval anatomises in portal hypertension etc. 3) Cirrhosis of liver 4) Scorpion sl/ings, Snake bites 5) Bacterial resistant infections - Septic shock 6) In conditions ? Coronary Artery diseases ? Myocardial Infarcts ? Following Cardio-Vascular Surgeries 7) Adult Respiratory distress Syndromes. 8) Multi-organ Dysfunction Syndrome 9) Poly - Cystic Kidney 10) Alzheimer's disease & many odier clinical conditions associated widi critical situations. These fluids by tiieir concurrant use in conditions like HIV and Australian Antigen Virus infestation may provide better results by restoring die cell and organ environment, to a near normal level, and assist die defence mechanism of die body they have benificial effects on the cell membrane. These situations may be occuring in non-diabetic individuals or manifest diabetic individuals. They can be treated accordingly.

Full Text

The fluid formulation composed is needed in the treatment needing resuscitation of clinical conditions. It consists
1. Energy substrate in the form of Dextrose
2. The active catalyst in the form of soluble (Bovine-Human) Insulin
3. The electrolytes in the form of K, Ca
4. KC1, Calcium gluconate and other electrolytes With an option of containing additional like
5. Vitamins
6. Heparin
7. Amino acids
8. Lipids
The author believes all these are required regularly in the management of patients by way of facilitating the homeostatic mechanism of the body to regulate the balance disturbed. Though the complex homeostatic mechanism of the body has enormous capability to rectify all the resultant adverse changes of Stress Shock and various critical conditions can still get vitiated further if not handled with proper understanding.
The commonly used present remedy needs to be improved based on the authors all along advocated and practiced concept. More so now as more and more supportive informations are available to provide supportive firmer background to the concept.
With the help of brief understandable abreviative denotative informations indicating their use, the various types of solutions can be made available.
These will enable larger section of the profession with reasonable understanding of the clinical condition as well as the composition and their use will enable them to use these fluids with a large scope to gain better outcomes.
Background
Patients receive intravenous fluids in the form of nutrients minerals vitamins antibiotics and other life saving drugs in a number of clinical conditions. It is also proved to be reliable and effective means of providing them for reliable, and predictable effects with minimum of inconvenience to the patients.
This may be the only means of treatment feasible on many occasions as a measure of resuscitative procedure to revive the patients from critically ill state to a state of survival and back to normal life.
The presently available fluids are inadequate in all aspect except the water content of the need of the patient. They are hypotonic in effect even though they are isotonic when used in critical conditions. The author has been feeling, the needs of the patients under such circumstances by the presently infused fluids are hardly met, thus putting the patient in a state of disadvantage to face the clinical condition and to recover back to normal.
Preamble
With the development of science the desires and expectations of the patients keep on improving in terms of better results, at less cost, effort, and loss of working time, in previously treatable cases and revival and prolongation of life when earlier they were not possible. Much has been achieved in these directions in medical science. As part of the treatment even till today on quite few occasions the existing intravenous infusions consisting

mainly water dextrose electrolytes. Subsequently the same route has been utilised for administration of antibiotics, proteins and lipid solutions along with many other soluble materials needed in particular instances.
The commonly used solutions are in packing of 500 ml
1. 5% Dextrose
2. 0. 9% NaCl solutions
3. Ringers lactate solutions etc. All these have been used, as basic fluids when patient needed administration of therapeutic fluids and other ingredients. In certain special circumstances, fluids like

1. 10% Dextrose
2. 10% Dextrose in normal saline (0.9%)
3. 20-25% Dextrose
4. Dialysis fluids
5. Blood and blood components
6. Low Molecular Dextrans
7. Mannitol and
8. Bulk form antibiotics
With the further development of science, it has been evident that, we have been providing insufficient and inadequate calories, from limited sources of these needed calories by way of energy substrates, electrolytes, vitamins and other needed elements. This late awareness of inadequate knowledge of stress, shock, and critical conditions has resulted in many centres to put up added attention and efforts to study and evaluate the effects. This has lead to more specific and other related information available. All these stress on the need to restore homeostasis towards normal, by restoring tissue perfusion and acid base balance towards normal. This will enable to improve the condition, to revive and restore normalcy, as has been stressed all along by the author.
The presently available fluids are
1. Unable to meet the calorie need of the patient. These needed calories require to originate from dextrose, amino acids, and lipids.
2. Unable to meet the electrolytes required by the patient, in terms of variety and quantity, as well as
3. Unable to utilise, the energy substrate and electrolytes available, in view of high levels of catacholamines.
All these result in a state of catabolism and their consequential effects on the body is aptly described as a state of auto-cannibalism. We need to stop or prevent this from happening. This emphasizes the need of infusions providing the needs of the body in terms of, calorie, electrolytes, substrates, vitamins and other essentials to enable and utilise to treat, improve, revive and restore normalcy.
Prophylactic measures on this line of approach in expected situations like major operative procedures should enable one to minimise the risks of the procedure considerably.
The fluids needed are broadly categorised for use to suit the various situations. The following abbreviations are used to denote the fluid and their possible place of use. These abbreviations are denoted as G-Gangal, N- Non-diabetic, D-Diabetic E-Electrolytes, H-Heparin, V-Vitamins, I-Insulin, PL-Plain/Soluble bovine potentially equivalent Human insulin preferred. Dext-Dextrose.
A.E - Actual electrolytes to replace the Extra cellular electrolytes, A.M - Actual electrolytes needed in Maintenance solutions as are presently available, to be taken as

With these improved formulations, it has been possible to meet die largely needed requirements under various types of critical clinical conditions, as can be rationalised today.
One should appreciate, though these formulations may be able to meet the needed requirements, will enable us to standardise the approach, and give scope in a better way to improve further the formulations, thus enabling us to gain still further occasion to improve, the formulation to attain better results within scope of the appended claims in formulations. We may also gain better and larger scope of their use in various other conditions, like omiting Heparin in where ever it is felt better to omit.
The formulations consists of the following and other ingredients mentioned in the above clarifications and in the text.
1. Water: The main and die essential ingredient of die body, acting as media /vehicle to mention die circulation of nutrients, essentials and to remove wastes from die body .It helps to mentain physiological state in and around die body congenial to sustain normal life.
Water is a natural component of die body, and is also die main vehicle / media dirough which die body's circulation is mentained. This makes it possible die essentials of life and function are made available from die body to die cell level and receives back the wastes from die cell level to die organ to be eliminated out of die body. The volume of die water needed by die body varies widi the functional level, the problems faced and die environment. Accordingly the volume of fluid needed to be infused -to balance die need and die output and also to mentain effective circulation - are required into consideration to asses.
2. Dextrose: A major source of energy out of all odier essential energy substrates. A must for living and
sustaining life.
Dextrose in die form of 5% as an isotonic soludon has been the main stay of intravenous infusion in all forms of condidons where infusion forms die treatment as well as a resuscitative measure. In states of stress, shock, and cridcal conditions, diis isotonic will have an effect of hypotonic solution. Thus, likely to cause enormous harmful effects. Here it is used in hypertonic form to enable it to provide needed higher calories along with higher amounts of insulin, and also avoid effects of hypotonic solutions. Normally it forms the main source of energy to be supplemented by aminoacids, and emulsified fat soludons. This helps to meet die needs of essential aminoacids, and also fats, along widi enables to prevent die bad and rebound effects of prolonged use of carbohydrates alone. This results in accumulation of acidic components and triggering of catacholamine response, -indeed an unwanted response at an odd occasion to result in further effects to an already critical condition. Here I use 10%, 15%, 20%, and along widi insulin, electrolytes, vitamins, and Heparin. I need to provide higher amount of dextrose to meet die high levels of metabolism. This is likely to avoid autocannibalism and its consequent outcome of survival.
3. Na: Sodium chloride forms a major and a main electrolyte. It is also called die 2end pump to mentain
the circulation.
Sodium Chloride : 0.9% Nacl is an isotonic soludon, commonly used as such or in combination widi Dextrose solutions. It is one of die main electrolyte, die body needs. It is mainly an extra cellular electrolyte widi a small intracellular component, having a reciprocal gradient relation widi K ion responding to any effective agents. The intake and output needs to be balanced. It is commonly used as such or along widi 5% or 10% Dextrose solutions.
The body contains a-large amount, Hearing around 5000 mEq of Na, widi an average need of, 80 - 100, mEq / Day. This is mostly lost in die urine. In die normal individual, on one hand diere is a large reserve, on die odier hand diere is an excellent mechanism to conserve by normal functioning kidney. This can result in bringing urinary loss of Na to zero, in die absence of intake of Na. Still large

fluctuations do occur with resultant serious problems. Hence it needs to be managed properly to retain homeostasis
4. Ca; Calcium similarly forms a major cation component of the body, having role to play in
homeostasis, membrane potentials, inter cellular junctions and cell functions.
Calcium: Calcium is a major component of the body forming around 2% of the bodyweight 99% of it is in the form of bone. Part of it is constantly changing to contribute to the extra-cellular component. This is under die influence of simple ion exchange. Paradiarmone, Vit D, Corticosteroids cause disturbances in Calcium content.
Any, variations in die extra-cellular component affects die homeostasis, which in turn results in deranged cellular functions. Average Indian diet may contain as low as 0.2 gins as against die daily need of 0.5 to 0.6 gm on an average.
The needs are higher in later terms of pregnancy and lactation - dius needing up to around 1 gram of Calcium a day. Intracellular Ca regulates cell metabolism, ifs function and inter junctional permeability.
Willi normally functioning kidneys, 99% of the Ca gets reabsorbed from die tubules: Urinary Ca excretion increases with hypercalcemia of any cause, metabolic acidosis and use of cortisones. .
Ca is an important component of the cell membrane and competes widi Na. Raised Ca, in blood increases the threshold for contraction and low Ca leads to tetany.
Ca also plays role in coagulation of blood, coupling mechanism between excitation and contraction of muscles, and secretary mechanism of Insulin.
5. K: Potassium mainly an intracellular electrolyte having a significant role to play in cell membrane
potentials and cell functions.
Potassium chloride: Kcl solution is available for intravenous use, needs to be diluted considerably to use. Normally-diere is about 3500 mEq of Potassium in the body, of which 98%is intracellular and hardly 2% is in extra-cellular compartment. This small part of the Potassium plays a major role in the functioning of the smooth, skeletal, and cardiac muscles, as a result any variations that occur in its level can certainly cause considerable problems.
Seventy-five percent of the Potassium is found in the skeletal muscles. Normally on an average die body needs around 50 to 80 mEq of Potassium per day. The main route of loss is through normally functioning kidney. The minimum that is lost dirough urine could be 20 mEq even in the absence of Potassium intake.
In view of the high quantity of Potassium is in intracellular compartment any injury to die organs is bound to increase die extra-cellular Potassium. It is to a certain extent dependent on die level of Sodium, oUier hormones and diuretics. Its movements / transfer is related to metabolism.
There are occasions where intracellular Potassium deficiency may be present aldiough die plasma level is normal, Such situations need careful evaluation dian casual look.
6. Other electrolytes: As are included in the Arolyte solutions are also essential to die body function and
are required to be ment7ained in balance.
All diese have been used in clinical application.

7. Insulin: Insulin is an essential hormone required in die process of metabolism of carbohydrates,
proteins, and fats. Involving almost all organs in the body.
8, Heparin: It is a naturally occurring substance, not occurring in blood to a measurable extent, prevents
blood coagulation. It plays significant role in cases of trauma induced on any account.
Blood coagulation is essentially a series of enzymatic reactions involving a number of plasma proteins. Many of these are present only in traces. Within an intact healthy circulatory system these enzymes, for the most part, are in an inactive form, when the blood is shed on wetable surfaces, a series of autocatalytic enzymatic reaction is initiated - this is a process of - more complex and confused in results, interpretations, and opinions.
To make order out of such chaos an international system of numbering has been introduced for the identification of those factors accepted by majority of authorities in the field.
Tissue extracts are also known to accelerate the clotting of whole blood. This tissue extract known as thromboplastin-requires lipid and protein constituents for full activity.
When this action is initiated by blood constituents is called intrinsic, when initiated by tissue extract thromsoplastin is called extrinsic source. Though they start differently to begin with final process of coagulation is common to both forms of initiations.
Heparin - is not present in normal blood in measurable amount. It does not prevent blood coagulation. When added as a therapeutic agent. It acts at a number of sites along the chain of reaction. Its probable initial, action is to prevent die development of Uiromboplastin activity.
Heparin has immediate action on die coagulation system. It is a naturally occurring sulfonated polysaccharide with strong anticoagulant action. It is rapidly inactivated and removed from die circulation. It is difficult to maintain dierapeudc level in die blood while avoiding die danger from bleeding. Here it is used to prevent likely initiation of early thrombo - embolic phenominon.
In die present situation medical science is not as exact as madiematics and it may not be so forever. Life science is so complex, and every effort, eidier to understand, evaluate, or treat, involves, time, money, risk and need of invasive procedures, widi added risks.
9. Vitamins: Fat mid water-soluble vitamins are organic compounds, forming as components or cofactors for enzymes concerned widi metabolism of carbohydrates, fats, and proteins.
Most of the vitamins are acquired from dietary sources. Very few to a small extent are synthesised in die body.
B. Group vitamins act, as essential co-enzymes required as intermediary in die metabolism.
Dietary vitamins need to be converted to its co-enzyme form in order to be useful. It is also noted diese vitamins are interdependent on dieir metabolism and utilisation. In the absence of sources of supply, use of various drugs affecting their metabolism, diat too under circumstances of raised metabolic state, diere, does occur an occasion to provide diese needed Vitamins in the form of intravenous administration.
These Vitamins are classified, as
Fat Soluble Vitamins, - A D.E.K - are stored in die body.
Water Soluble Vitamins, - B Group & C are not stored and any excess is rapidly excreted in die urine. They arc not toxic. And tend not to cause interaction widi drugs.

This likely Vitamin deficiency occurring during total parenteral nutrition, and parenteral therapy, are attended by providing as follows.
Vitamin A-Daily dose of around 10,000 to 20,000 I.U in the form of made as water soluble could be essential to mentain the integrity of the epithelial cells, synthesis of glucocortcoids, cholesterol, and for somatic growth, upper respiratory tract epithelium.
Vitamin D- To facilitate interdepartmental metabolism between vitamins, and to .mentain Ca. Homeostasis. It is quite important in the acute conditions-like, mobilisation of insulin, coupling mechanism of excitation and contraction mechanism of muscles. These have some relevance to diabetes normal organ function and essential hypertension.
Vitamin Bi - are mainly concerned with Carbohydrate metabolism. IV / IM administration of large doses may cause anaphylactic shock and interfere with action of other B vitamins.
B3 - Nicotinic acid is required in Protein metabolism, necessary in respiration
B6 - Indirectly affects carbohydrate metabolism, directly the catacholamines, gamma-amin obutyricacid,etc,
B7 - is involved in fundamental biological reactions.
B12 - is necessary in mentainance of function of the nervous system and conduction mechanism.
C - Concerned with cellular respiration / oxidation-reduction reactions, and Formation of collagen, intercellular matrix development of cartilage, wound healing, carbohydrate metabolism.
E - Alpha Tocopheryl Acetate is said to be essential to maintain integrity and stability of biological membranes, normal structure and function of the nervous system and is mostly used on an empirical base. It is known to be antioxydent.
l)Choline Chloride is akin to B group of Vitamins but synthesised in the human body. It plays an important role as a structural component of tissues and in biological methilation reactions.
It is a precursor of acetylcholine, and some hormones. Its biogenesis is universal in nature. It helps to spare aminoacids in protein synthesis.
It prevents fatty infiltration of liver - a hypertropic agent, average estimated consumption appears to be around 500 to 900 mgm/a day.
Di: Methionine - is sulphur containing aminoacid and inseparable dietary component. Methionine has lipotropic action, and is considered as useful adjutant of treatment of liver diseases. It enhances synthesis of glutathione, necessary for detoxification of toxic metabolites of paracetamol. Average needs are around 200 to 500 mgm.
Inosital - occurs in nearly all plant, and animal cell, suggesting it to be an essential cell constituent. It is found to be a constituent of an amylase enzyme system. To a certain extent it is syntiiesised by die intestinal flora. It possesses weak lipotropic activity prevents fatty liver. It could be beneficial in diabetic neuropathy.
Stress, trauma, shock, critical conditions, sepsis, surgery increase the catabolic rate. This increased catabolism is a self-destructive response to the above stated illnesses, It is termed as auto cannibalism needing everyone* s attention to prevent it occurring.

The developments in medical sciences appear to have been based mostly on die outcome of interested individuals efforts. There has been no systematic developmental effort to study life science, as it stands smaller priority, in the Government and personal levels. Hence allocation of funds in comparison with defence, industry etc are very meagre. In such circumstances the evaluations are difficult. Presently adopted methods of treatment are largely based on the individual knowledge, and capability to evaluate the condition he is handling. Thus giving large scope for variations and the resultant outcomes.
On the background of the experience in the experimental surgery in developing open heart surgery mid handling critically ill patients, major trauma patients, the concept adopted by me and resultant comparatively better outcomes led me to continue the work and peruse to gain further information on die line. I continued to try the concept in conditions where die senior colleagues could not expect any hope (widi appreciable good results), convinced me, die approach stands better scope in die present situation. Widi more and more information now available, die scope of use of my concept has enlarged and die results have proved its wordiiness to be perused. It needs fair variations widi die fundamental concept remaining to be die backbone in all its variant approach in different clinical pictures.
I feel stress, trauma, shock critical conditions, surgery infections cause a state of disturbed neuro hormonal response resulting in changed hormonal catachalamine levels, homeostatic conditions, altered level of defence mechanism and metabolism. All needs to be attended, to provide proper physiological response to restore normalcy and recovery. This needs my approach to be well-balanced, gradual, predictable and reasonable, to gain near natural normal life, witiiout die need of prolonged Uicrapy assisted sustenance of life.
1) I also feel -every individual is potentially diabetic, hypertensive-more so under states of stress and allied situations is now corroborated by quite a few,
2) There is a raised metabolism under states of stress & critical condition leading to autocannibalism- a worst situation - leading to multiple organ dysfunction syndromes.
As a preventive measure to minimise such occurrences, I use diese fluids, in
1) Stress - Primary Hypertension Angina pectoris.
2) Shock,

a) Multiple traumatic injuries.
b) Perforative peritonitis
c) Pancreatitis
d) Major operative procedures
e) Major vascular surgeries.
Like dirombo-end artercctomics
Mesocaval anatomises in portal hypertension etc.
3) Cirrhosis of liver
4) Scorpion sl/ings, Snake bites
5) Bacterial resistant infections - Septic shock
6) In conditions

? Coronary Artery diseases
? Myocardial Infarcts
? Following Cardio-Vascular Surgeries

7) Adult Respiratory distress Syndromes.
8) Multi-organ Dysfunction Syndrome
9) Poly - Cystic Kidney
10) Alzheimer's disease & many odier clinical conditions associated widi critical situations.
These fluids by tiieir concurrant use in conditions like HIV and Australian Antigen Virus
infestation may provide better results by restoring die cell and organ environment, to a near
normal level, and assist die defence mechanism of die body they have benificial effects on the cell
membrane.
These situations may be occuring in non-diabetic individuals or manifest diabetic individuals.
They can be treated accordingly.

The fluid formulation composed is needed in the treatment needing resuscitation of clinical conditions. It consists
1. Energy substrate in the form of Dextrose
2. The active catalyst in the form of soluble (Bovine-Human) Insulin
3. The electrolytes in the form of K, Ca
4. KC1, Calcium gluconate and other electrolytes With an option of containing additional like
5. Vitamins
6. Heparin
7. Amino acids
8. Lipids
The author believes all these are required regularly in the management of patients by way of facilitating the homeostatic mechanism of the body to regulate the balance disturbed. Though the complex homeostatic mechanism of the body has enormous capability to rectify all the resultant adverse changes of Stress Shock and various critical conditions can still get vitiated further if not handled with proper understanding.
The commonly used present remedy needs to be improved based on the authors all along advocated and practiced concept. More so now as more and more supportive informations are available to provide supportive firmer background to the concept.
With the help of brief understandable abreviative denotative informations indicating their use, the various types of solutions can be made available.
These will enable larger section of the profession with reasonable understanding of the clinical condition as well as the composition and their use will enable them to use these fluids with a large scope to gain better outcomes.
Background
Patients receive intravenous fluids in the form of nutrients minerals vitamins antibiotics and other life saving drugs in a number of clinical conditions. It is also proved to be reliable and effective means of providing them for reliable, and predictable effects with minimum of inconvenience to the patients.
This may be the only means of treatment feasible on many occasions as a measure of resuscitative procedure to revive the patients from critically ill state to a state of survival and back to normal life.
The presently available fluids are inadequate in all aspect except the water content of the need of the patient. They are hypotonic in effect even though they are isotonic when used in critical conditions. The author has been feeling, the needs of the patients under such circumstances by the presently infused fluids are hardly met, thus putting the patient in a state of disadvantage to face the clinical condition and to recover back to normal.
Preamble
With the development of science the desires and expectations of the patients keep on improving in terms of better results, at less cost, effort, and loss of working time, in previously treatable cases and revival and prolongation of life when earlier they were not possible. Much has been achieved in these directions in medical science. As part of the treatment even till today on quite few occasions the existing intravenous infusions consisting

mainly water dextrose electrolytes. Subsequently the same route has been utilised for administration of antibiotics, proteins and lipid solutions along with many other soluble materials needed in particular instances.
The commonly used solutions are in packing of 500 ml
1. 5% Dextrose
2. 0. 9% NaCl solutions
3. Ringers lactate solutions etc. All these have been used, as basic fluids when patient needed administration of therapeutic fluids and other ingredients. In certain special circumstances, fluids like

1. 10% Dextrose
2. 10% Dextrose in normal saline (0.9%)
3. 20-25% Dextrose
4. Dialysis fluids
5. Blood and blood components
6. Low Molecular Dextrans
7. Mannitol and
8. Bulk form antibiotics
With the further development of science, it has been evident that, we have been providing insufficient and inadequate calories, from limited sources of these needed calories by way of energy substrates, electrolytes, vitamins and other needed elements. This late awareness of inadequate knowledge of stress, shock, and critical conditions has resulted in many centres to put up added attention and efforts to study and evaluate the effects. This has lead to more specific and other related information available. All these stress on the need to restore homeostasis towards normal, by restoring tissue perfusion and acid base balance towards normal. This will enable to improve the condition, to revive and restore normalcy, as has been stressed all along by the author.
The presently available fluids are
1. Unable to meet the calorie need of the patient. These needed calories require to originate from dextrose, amino acids, and lipids.
2. Unable to meet the electrolytes required by the patient, in terms of variety and quantity, as well as
3. Unable to utilise, the energy substrate and electrolytes available, in view of high levels of catacholamines.
All these result in a state of catabolism and their consequential effects on the body is aptly described as a state of auto-cannibalism. We need to stop or prevent this from happening. This emphasizes the need of infusions providing the needs of the body in terms of, calorie, electrolytes, substrates, vitamins and other essentials to enable and utilise to treat, improve, revive and restore normalcy.
Prophylactic measures on this line of approach in expected situations like major operative procedures should enable one to minimise the risks of the procedure considerably.
The fluids needed are broadly categorised for use to suit the various situations. The following abbreviations are used to denote the fluid and their possible place of use. These abbreviations are denoted as G-Gangal, N- Non-diabetic, D-Diabetic E-Electrolytes, H-Heparin, V-Vitamins, I-Insulin, PL-Plain/Soluble bovine potentially equivalent Human insulin preferred. Dext-Dextrose.
A.E - Actual electrolytes to replace the Extra cellular electrolytes, A.M - Actual electrolytes needed in Maintenance solutions as are presently available, to be taken as

With these improved formulations, it has been possible to meet die largely needed requirements under various types of critical clinical conditions, as can be rationalised today.
One should appreciate, though these formulations may be able to meet the needed requirements, will enable us to standardise the approach, and give scope in a better way to improve further the formulations, thus enabling us to gain still further occasion to improve, the formulation to attain better results within scope of the appended claims in formulations. We may also gain better and larger scope of their use in various other conditions, like omiting Heparin in where ever it is felt better to omit.
The formulations consists of the following and other ingredients mentioned in the above clarifications and in the text.
1. Water: The main and die essential ingredient of die body, acting as media /vehicle to mention die circulation of nutrients, essentials and to remove wastes from die body .It helps to mentain physiological state in and around die body congenial to sustain normal life.
Water is a natural component of die body, and is also die main vehicle / media dirough which die body's circulation is mentained. This makes it possible die essentials of life and function are made available from die body to die cell level and receives back the wastes from die cell level to die organ to be eliminated out of die body. The volume of die water needed by die body varies widi the functional level, the problems faced and die environment. Accordingly the volume of fluid needed to be infused -to balance die need and die output and also to mentain effective circulation - are required into consideration to asses.
2. Dextrose: A major source of energy out of all odier essential energy substrates. A must for living and
sustaining life.
Dextrose in die form of 5% as an isotonic soludon has been the main stay of intravenous infusion in all forms of condidons where infusion forms die treatment as well as a resuscitative measure. In states of stress, shock, and cridcal conditions, diis isotonic will have an effect of hypotonic solution. Thus, likely to cause enormous harmful effects. Here it is used in hypertonic form to enable it to provide needed higher calories along with higher amounts of insulin, and also avoid effects of hypotonic solutions. Normally it forms the main source of energy to be supplemented by aminoacids, and emulsified fat soludons. This helps to meet die needs of essential aminoacids, and also fats, along widi enables to prevent die bad and rebound effects of prolonged use of carbohydrates alone. This results in accumulation of acidic components and triggering of catacholamine response, -indeed an unwanted response at an odd occasion to result in further effects to an already critical condition. Here I use 10%, 15%, 20%, and along widi insulin, electrolytes, vitamins, and Heparin. I need to provide higher amount of dextrose to meet die high levels of metabolism. This is likely to avoid autocannibalism and its consequent outcome of survival.
3. Na: Sodium chloride forms a major and a main electrolyte. It is also called die 2end pump to mentain
the circulation.
Sodium Chloride : 0.9% Nacl is an isotonic soludon, commonly used as such or in combination widi Dextrose solutions. It is one of die main electrolyte, die body needs. It is mainly an extra cellular electrolyte widi a small intracellular component, having a reciprocal gradient relation widi K ion responding to any effective agents. The intake and output needs to be balanced. It is commonly used as such or along widi 5% or 10% Dextrose solutions.
The body contains a-large amount, Hearing around 5000 mEq of Na, widi an average need of, 80 - 100, mEq / Day. This is mostly lost in die urine. In die normal individual, on one hand diere is a large reserve, on die odier hand diere is an excellent mechanism to conserve by normal functioning kidney. This can result in bringing urinary loss of Na to zero, in die absence of intake of Na. Still large

fluctuations do occur with resultant serious problems. Hence it needs to be managed properly to retain homeostasis
4. Ca; Calcium similarly forms a major cation component of the body, having role to play in
homeostasis, membrane potentials, inter cellular junctions and cell functions.
Calcium: Calcium is a major component of the body forming around 2% of the bodyweight 99% of it is in the form of bone. Part of it is constantly changing to contribute to the extra-cellular component. This is under die influence of simple ion exchange. Paradiarmone, Vit D, Corticosteroids cause disturbances in Calcium content.
Any, variations in die extra-cellular component affects die homeostasis, which in turn results in deranged cellular functions. Average Indian diet may contain as low as 0.2 gins as against die daily need of 0.5 to 0.6 gm on an average.
The needs are higher in later terms of pregnancy and lactation - dius needing up to around 1 gram of Calcium a day. Intracellular Ca regulates cell metabolism, ifs function and inter junctional permeability.
Willi normally functioning kidneys, 99% of the Ca gets reabsorbed from die tubules: Urinary Ca excretion increases with hypercalcemia of any cause, metabolic acidosis and use of cortisones. .
Ca is an important component of the cell membrane and competes widi Na. Raised Ca, in blood increases the threshold for contraction and low Ca leads to tetany.
Ca also plays role in coagulation of blood, coupling mechanism between excitation and contraction of muscles, and secretary mechanism of Insulin.
5. K: Potassium mainly an intracellular electrolyte having a significant role to play in cell membrane
potentials and cell functions.
Potassium chloride: Kcl solution is available for intravenous use, needs to be diluted considerably to use. Normally-diere is about 3500 mEq of Potassium in the body, of which 98%is intracellular and hardly 2% is in extra-cellular compartment. This small part of the Potassium plays a major role in the functioning of the smooth, skeletal, and cardiac muscles, as a result any variations that occur in its level can certainly cause considerable problems.
Seventy-five percent of the Potassium is found in the skeletal muscles. Normally on an average die body needs around 50 to 80 mEq of Potassium per day. The main route of loss is through normally functioning kidney. The minimum that is lost dirough urine could be 20 mEq even in the absence of Potassium intake.
In view of the high quantity of Potassium is in intracellular compartment any injury to die organs is bound to increase die extra-cellular Potassium. It is to a certain extent dependent on die level of Sodium, oUier hormones and diuretics. Its movements / transfer is related to metabolism.
There are occasions where intracellular Potassium deficiency may be present aldiough die plasma level is normal, Such situations need careful evaluation dian casual look.
6. Other electrolytes: As are included in the Arolyte solutions are also essential to die body function and
are required to be ment7ained in balance.
All diese have been used in clinical application.

7. Insulin: Insulin is an essential hormone required in die process of metabolism of carbohydrates,
proteins, and fats. Involving almost all organs in the body.
8, Heparin: It is a naturally occurring substance, not occurring in blood to a measurable extent, prevents
blood coagulation. It plays significant role in cases of trauma induced on any account.
Blood coagulation is essentially a series of enzymatic reactions involving a number of plasma proteins. Many of these are present only in traces. Within an intact healthy circulatory system these enzymes, for the most part, are in an inactive form, when the blood is shed on wetable surfaces, a series of autocatalytic enzymatic reaction is initiated - this is a process of - more complex and confused in results, interpretations, and opinions.
To make order out of such chaos an international system of numbering has been introduced for the identification of those factors accepted by majority of authorities in the field.
Tissue extracts are also known to accelerate the clotting of whole blood. This tissue extract known as thromboplastin-requires lipid and protein constituents for full activity.
When this action is initiated by blood constituents is called intrinsic, when initiated by tissue extract thromsoplastin is called extrinsic source. Though they start differently to begin with final process of coagulation is common to both forms of initiations.
Heparin - is not present in normal blood in measurable amount. It does not prevent blood coagulation. When added as a therapeutic agent. It acts at a number of sites along the chain of reaction. Its probable initial, action is to prevent die development of Uiromboplastin activity.
Heparin has immediate action on die coagulation system. It is a naturally occurring sulfonated polysaccharide with strong anticoagulant action. It is rapidly inactivated and removed from die circulation. It is difficult to maintain dierapeudc level in die blood while avoiding die danger from bleeding. Here it is used to prevent likely initiation of early thrombo - embolic phenominon.
In die present situation medical science is not as exact as madiematics and it may not be so forever. Life science is so complex, and every effort, eidier to understand, evaluate, or treat, involves, time, money, risk and need of invasive procedures, widi added risks.
9. Vitamins: Fat mid water-soluble vitamins are organic compounds, forming as components or cofactors for enzymes concerned widi metabolism of carbohydrates, fats, and proteins.
Most of the vitamins are acquired from dietary sources. Very few to a small extent are synthesised in die body.
B. Group vitamins act, as essential co-enzymes required as intermediary in die metabolism.
Dietary vitamins need to be converted to its co-enzyme form in order to be useful. It is also noted diese vitamins are interdependent on dieir metabolism and utilisation. In the absence of sources of supply, use of various drugs affecting their metabolism, diat too under circumstances of raised metabolic state, diere, does occur an occasion to provide diese needed Vitamins in the form of intravenous administration.
These Vitamins are classified, as
Fat Soluble Vitamins, - A D.E.K - are stored in die body.
Water Soluble Vitamins, - B Group & C are not stored and any excess is rapidly excreted in die urine. They arc not toxic. And tend not to cause interaction widi drugs.

This likely Vitamin deficiency occurring during total parenteral nutrition, and parenteral therapy, are attended by providing as follows.
Vitamin A-Daily dose of around 10,000 to 20,000 I.U in the form of made as water soluble could be essential to mentain the integrity of the epithelial cells, synthesis of glucocortcoids, cholesterol, and for somatic growth, upper respiratory tract epithelium.
Vitamin D- To facilitate interdepartmental metabolism between vitamins, and to .mentain Ca. Homeostasis. It is quite important in the acute conditions-like, mobilisation of insulin, coupling mechanism of excitation and contraction mechanism of muscles. These have some relevance to diabetes normal organ function and essential hypertension.
Vitamin Bi - are mainly concerned with Carbohydrate metabolism. IV / IM administration of large doses may cause anaphylactic shock and interfere with action of other B vitamins.
B3 - Nicotinic acid is required in Protein metabolism, necessary in respiration
B6 - Indirectly affects carbohydrate metabolism, directly the catacholamines, gamma-amin obutyricacid,etc,
B7 - is involved in fundamental biological reactions.
B12 - is necessary in mentainance of function of the nervous system and conduction mechanism.
C - Concerned with cellular respiration / oxidation-reduction reactions, and Formation of collagen, intercellular matrix development of cartilage, wound healing, carbohydrate metabolism.
E - Alpha Tocopheryl Acetate is said to be essential to maintain integrity and stability of biological membranes, normal structure and function of the nervous system and is mostly used on an empirical base. It is known to be antioxydent.
l)Choline Chloride is akin to B group of Vitamins but synthesised in the human body. It plays an important role as a structural component of tissues and in biological methilation reactions.
It is a precursor of acetylcholine, and some hormones. Its biogenesis is universal in nature. It helps to spare aminoacids in protein synthesis.
It prevents fatty infiltration of liver - a hypertropic agent, average estimated consumption appears to be around 500 to 900 mgm/a day.
Di: Methionine - is sulphur containing aminoacid and inseparable dietary component. Methionine has lipotropic action, and is considered as useful adjutant of treatment of liver diseases. It enhances synthesis of glutathione, necessary for detoxification of toxic metabolites of paracetamol. Average needs are around 200 to 500 mgm.
Inosital - occurs in nearly all plant, and animal cell, suggesting it to be an essential cell constituent. It is found to be a constituent of an amylase enzyme system. To a certain extent it is syntiiesised by die intestinal flora. It possesses weak lipotropic activity prevents fatty liver. It could be beneficial in diabetic neuropathy.
Stress, trauma, shock, critical conditions, sepsis, surgery increase the catabolic rate. This increased catabolism is a self-destructive response to the above stated illnesses, It is termed as auto cannibalism needing everyone* s attention to prevent it occurring.

The developments in medical sciences appear to have been based mostly on die outcome of interested individuals efforts. There has been no systematic developmental effort to study life science, as it stands smaller priority, in the Government and personal levels. Hence allocation of funds in comparison with defence, industry etc are very meagre. In such circumstances the evaluations are difficult. Presently adopted methods of treatment are largely based on the individual knowledge, and capability to evaluate the condition he is handling. Thus giving large scope for variations and the resultant outcomes.
On the background of the experience in the experimental surgery in developing open heart surgery mid handling critically ill patients, major trauma patients, the concept adopted by me and resultant comparatively better outcomes led me to continue the work and peruse to gain further information on die line. I continued to try the concept in conditions where die senior colleagues could not expect any hope (widi appreciable good results), convinced me, die approach stands better scope in die present situation. Widi more and more information now available, die scope of use of my concept has enlarged and die results have proved its wordiiness to be perused. It needs fair variations widi die fundamental concept remaining to be die backbone in all its variant approach in different clinical pictures.
I feel stress, trauma, shock critical conditions, surgery infections cause a state of disturbed neuro hormonal response resulting in changed hormonal catachalamine levels, homeostatic conditions, altered level of defence mechanism and metabolism. All needs to be attended, to provide proper physiological response to restore normalcy and recovery. This needs my approach to be well-balanced, gradual, predictable and reasonable, to gain near natural normal life, witiiout die need of prolonged Uicrapy assisted sustenance of life.
1) I also feel -every individual is potentially diabetic, hypertensive-more so under states of stress and allied situations is now corroborated by quite a few,
2) There is a raised metabolism under states of stress & critical condition leading to autocannibalism- a worst situation - leading to multiple organ dysfunction syndromes.
As a preventive measure to minimise such occurrences, I use diese fluids, in
1) Stress - Primary Hypertension Angina pectoris.
2) Shock,

a) Multiple traumatic injuries.
b) Perforative peritonitis
c) Pancreatitis
d) Major operative procedures
e) Major vascular surgeries.
Like dirombo-end artercctomics
Mesocaval anatomises in portal hypertension etc.
3) Cirrhosis of liver
4) Scorpion sl/ings, Snake bites
5) Bacterial resistant infections - Septic shock
6) In conditions

? Coronary Artery diseases
? Myocardial Infarcts
? Following Cardio-Vascular Surgeries

7) Adult Respiratory distress Syndromes.
8) Multi-organ Dysfunction Syndrome
9) Poly - Cystic Kidney
10) Alzheimer's disease & many odier clinical conditions associated widi critical situations.
These fluids by tiieir concurrant use in conditions like HIV and Australian Antigen Virus
infestation may provide better results by restoring die cell and organ environment, to a near
normal level, and assist die defence mechanism of die body they have benificial effects on the cell
membrane.
These situations may be occuring in non-diabetic individuals or manifest diabetic individuals.
They can be treated accordingly.

Documents:

1106-mas-1999 abstract-granded.pdf

1106-mas-1999 claims-granded.pdf

1106-mas-1999 description (complete)-granded.pdf

1106-mas-1999-abstract.pdf

1106-mas-1999-claims .pdf

1106-mas-1999-correspondence others.pdf

1106-mas-1999-correspondence po.pdf

1106-mas-1999-form 1.pdf

1106-mas-1999-form 19.pdf

1106-mas-1999-form 26.pdf

1106-mas-1999-form 3.pdf

1106-mas-1999-pct.pdf

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Patent Number

221292

Indian Patent Application Number

1106/MAS/1999

PG Journal Number

31/2008

Publication Date

01-Aug-2008

Grant Date

20-Jun-2008

Date of Filing

15-Nov-1999

Name of Patentee

Dr. GANGAL HANAMARADDI TIMARADDI

Applicant Address

P.B. ROAD & 3RD CROSS, HOSUR HUBLI - 580021

Inventors:

#	Inventor's Name	Inventor's Address
1	GANGAL HANAMARADDI TIMARADDI	P.B. ROAD & 3RD CROSS, HOSUR HUBLI - 580021

PCT International Classification Number

A61M 5/00

PCT International Application Number

N/A

PCT International Filing date

PCT Conventions:

#	PCT Application Number	Date of Convention	Priority Country
1			NA