Acetic acid (white vinegar), having an affinity for sodium, is supportive in lowering elevated sodium levels by displacing Na from NaCl and forming sodium acetate which is then cleared through the kidneys. Slow oral administration of one teaspoon of acetic acid (clear vinegar) per 8 ounces of water is suggested to address elevated sodium levels.

Ammonium Chloride (NH₄Cl)

Ammonium chloride, a combination of a labile cation and a fixed anion that acts as a diuretic, systemic acidifier, and expectorant. As the ammonium ion is converted to urea, the hydrogen ion is liberated reacting with bicarbonate with the end result of the chloride ion displacing the bicarbonate ion, ultimately converting to CO₂. Thus, the load of chlorides increases in the kidneys and an appreciable amount escapes reabsorption along with an equivalent quantity of cations (Na⁺) and an iso-osmotic quantity of H₂O. NH₄Cl is indicated in systemic alkalosis (indicating the need for hydrogen donors) with both nitrogen status and chlorides deeply depressed in the chemistry.

Conditions exhibiting low visceral proteins, creatinine, BUN, uric acid, and chlorides are indicative of poor nitrogen retention and would be responsive to buffered ammonium chloride administration in tablet form.

Aqueous Liver Concentrate

Aqueous liver concentrate from organic bovine liver is a gentle, but effective adjunct to replenishing iron stores. An excellent source of bioavailable iron, aqueous liver concentrate is an extract of liver without the cholesterol and lipids found in dietary sources of liver. Iron is a vital component in the synthesis of hemoglobin, myoglobin, and catecholamines. Its mode of action is by way of oxygen transport through hemoglobin (in blood) and myoglobin (in muscle) as well as by its enzymatic roles in energy transformations in the cell. Iron is involved with stimulation of xanthine oxidase, oxidative phosphorylation, catecholamine synthesis, cellular respiration, peroxide scavenging, electron transfer, systemic hormone action, ATP from cellular oxidation (cytochrome P450s), and some aspects of immune defense.

Bicarbonate

Sodium and potassium bicarbonate and/or sodium and potassium citrate may be indicated to support depressed CO₂ levels. Bicarbonate is secreted from the pancreas into the small intestine during digestion and may be used concurrently with lipase, protease, and amylase enzymes to support the digestive process.

Bromelain

Bromelain is a proteolytic enzyme present in the stem of pineapple that has been shown to alter pro-inflammatory prostaglandin synthesis by interfering with the arachadonic cascade in membrane phospholipids and therefore series 2 prostaglandins. Bromelain selectively stimulates the production of anti-inflammatory prostaglandin E1, possibly due to the formation of active peptides formed from fibrinolysis. Bromelain has been found affective in controlling edema, relieving angina pectoris, inhibiting platelet aggregation, and in the breakdown of atherosclerotic plaques.

Creatine

Creatine is found in the body most predominantly within skeletal muscle existing as both free creatine and the high energy phosphate form, creatine phosphate. Depletion in muscle of creatine phosphate occurs as a result of biochemical coupling of the conversion of creatine phosphate to creatine with the synthesis of ATP. This process is reversible by the enzyme ATP-creatine phosphokinase (CK or CPK). Creatine ultimately converts into creatinine beginning with transamination in the kidney between arginine and glycine forming guanidinoacetic acid and ornithine, methylation of quanidinoacetic acid by S-adenosylmethionine in the liver to create creatine being transported into muscle and ultimately in muscle both creatine and creatine phosphate (the rate is twice as fast for creatine phosphate) undergo a non enzymatic irreversible dehydration to form creatinine.

Creatinine is distributed in the total body fluids and is cleared through the kidney. Depressed levels of creatinine in serum may be indicative of catabolism, decreased muscle mass, inadequate dietary protein, malabsorption, malnutrition, and has recently been defined as a marker for a new treatable inborn error of metabolism as low creatine levels in the brain and low serum creatinine may lead to extrapyramidal movement disorders responsive to oral creatine supplementation.

Glutamine

Glutamine serves as a nitrogen transporter, regulator of protein synthesis, precursor for gluconeogenisis, ammonia donor, and a constituent of proteins. Glutamine is now considered to be a semi-essential amino acid as current research has indicated that tissue demands for glutamine can outstrip endogenous synthesis during acute illness. Exogenous administration of glutamine is supportive of gastrointestinal integrity (gut mass and barrier function against entry of pathogens/toxins) and nitrogen status (glutamine is now liberally added to enteral and TPN feeds to stabilize nitrogen).

Hydrochloric Acid (HCl)

Betaine hydrochloride is supportive of reduced stomach acid, achlorhydria, leading to disruptions in digestion and absorption. Diminished HCl may impair digestion and increase the potential allergenicity of foodstuffs. Gastric acidity has proven to be a relatively common condition associated with a number of illnesses and susceptibility to infection.

Lactoferrin

Bovine recombinant lactoferrin is a multifunctional immunoregulatory iron-binding protein that is closely related to the plasma iron-transporting protein transferrin. Lactoferrin is anti-inflammatory with anti fungal, anti viral, and antibacterial properties. It inhibits the production of several cytokines including tumor necrosis factor and interleuken-1. It is reported to induce CD4+ T-cell maturation preferentially over CD8+ T-cells. Lactoferrin's high affinity receptors have been identified on monocytes, macrophages, platelets, and lymphocytes. The proposed mechanism of lactoferrin is involvement in the hydrolysis of nucleic acids. The systemic concentration of human lactoferrin is down regulated during pregnancy (presumably to allow the maternal immune system to not reject the fetus) thus oral supplementation of lactoferrin is not appropriate during pregnancy. Lactoferrin supplementation is applicable in immune incompetency and conditions where iron, zinc and copper are in the wrong valence.

NADH

Nicotinamide-adenine-dinucleotide (NADH) also termed Coenzyme I is an electron donor essential for a variety of oxidation-reduction reactions (i.e., carbohydrate, protein, fat metabolism). NADH occurs in all living cells, playing a central role in cellular metabolism. It is supportive of the CNS in the activity of dopamine, noradrenaline, and serotonin. NADH has recently been isolated for oral supplementation. NADH would be applicable as a hydrogen donor thus indications in the chemistry would be elevation of CO₂ levels and markers associated with metabolic alkalosis. The higher the ratio of NADH to NAD the more potential the body has to create long chain fatty acids essential for prostanoid synthesis. Due to its function as an electron donor, NADH increases the rate of nitric oxide depletion this nitrogen markers (creatinine, BUN, uric acid, visceral proteins), nitric oxide (NO), and NOS (nitric oxide synthase) status must be considered.

Oral Electrolyte Solutions

The universal solvent, water, is the most abundant compound in the body and has the key role in the transport of nutrients, removal of waste products, regulation of cellular volume, and thermal control.

Body fluids are divided into two main compartments as extracellular (ECF) and intracellular fluids (ICF). Electrolytes are compounds dissolved within body fluids (solvent) as intracellular and extracellular fluids and are ionic solutes as anions (negatively charged ions gain electrons) and cations (positively charged ions give up electrons).

Major electrolytes are the cations: Sodium (Na⁺), Calcium (Ca⁺²), Magnesium (Mg⁺²), Potassium (K⁺) and the anions: Bicarbonate (HCO₃^-), Chloride (Cl^-), Phosphate (HPO₄^-2), and Sulfate (SO₄^-2). Bicarbonate concentration is determined from the CO₂ content. The accumulation of anions is determined by the formula: Anion Gap = (Na + K) - (HCO₃ + Cl). A high anion gap is a state of metabolic acidosis.

Within intracellular fluid electrolytes, potassium is the chief cation and phosphorus the chief anion. Within extracellular fluid, sodium is the chief cation and chloride is the chief anion. The extracellular preponderance of sodium ions and the intracellular preponderance of potassium ions are maintained by an energy (ATP) dependent cell membrane pump that exchanges sodium and potassium ions. For a homeostatic condition to exist, precise equal amounts of anions and cations must be present on either side of the cell membrane creating electrical neutrality to maintain osmolarity of body fluid compartments and control of pH.

Electrolyte concentrations were formerly measured as milliequivalents per liter (mEq/L) of serum or plasma. An equivalent weight or milliequivalent is the atomic weight of an atom or group of atoms (molecule) divided by its valence or coordination number. Since the concentrations of various electrolytes are small, they are expressed in milliequivalent weight or milliequivalents (1/1000 of an equivalent) per liter. The internal fluid of the human system works within severely limited tolerances of volume, acidity, and electrolyte concentrations. The units of mEq/L and mmol/L (millimole per liter) are identical for sodium, potassium, chloride, and bicarbonate. The divalent ions of magnesium and calcium are now expressed in a mass unit of mg/dL.

During illness, this delicate equilibrium is unstable as metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis, mixed metabolic acidosis/alkalosis, mixed respiratory acidosis/alkalosis, or even as triple acid-base disorders such as mixed metabolic acidosis and alkalosis combining with respiratory acidosis or alkalosis. Systemic abnormalities, even mild aberrations, of fluid, electrolyte and acid-base metabolism, can be addressed with appropriate oral electrolyte solution to stabilize the patient's chemistry.

Pancreatic Enzymes

Digestive support with plant derived enzymes containing protease, amylase, and lipase are applicable in metabolic signs of catabolism, depressed nitrogen and protein indicators and suppressed levels of bicarbonate to support digestion and assimilation of foodstuffs.

Tocotrienols

Tocotrienols are naturally existing farnesylated tocopherols, which are potent inhibitors of cholesterogenesis. It regulates cholesterol production by post-transcriptional suppression of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, appears to suppress cyclooxygenase activity, modulate hepatic cholesterol production, reduce plasma cholesterol levels, suppress low density lipoprotein cholesterol, and concomitantly increase lipogenic activity. Tocotrienols differ from tocopherols (Vitamin E) in three double bonds in the isoprenoid chain. Research indicates that alpha tocotrienol appears to be more effective in protecting against free radical-induced oxidative stress in membrane redox systems than alpha tocopherol. Alpha-tocopherol, however, does attenuate the cholesterol-suppressive action of the tocotrienols. Tocopherols are found primarily in low density lipoproteins and high density lipoproteins in association with plasma surface components, whereas tocotrienols become incorporated into circulating lipoproteins where they react with peroxyl radicals as efficiently as the corresponding tocopherol isomers.