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In addition to having direct pharmacological effects, IV nutrient therapy may be more effective than oral or IM treatment for correcting intracellular nutrient deficits. Some nutrients are present at much higher concentrations in the cells than in the serum. For example, the average magnesium concentration in myocardial cells is 10 times higher than the extracellular concentration. This ratio is maintained in healthy cells by an active-transport system that continually pumps magnesium ions into cells against the concentration gradient. In certain disease states, the capacity of membrane pumps to maintain normal concentration gradients may be compromised. In one study, the mean myocardial magnesium concentration was 65-percent lower in patients with cardiomyopathy than in healthy controls 10 implying a reduction in the intracellular-to-extracellular ratio to less than 4-to-1. As magnesium plays a key role in mitochondrial energy production, intracellular magnesium deficiency may exacerbate heart failure and lead to a vicious cycle of further intracellular magnesium loss and more severe heart failure. Intravenous administration of magnesium, by producing a marked, though transient, increase in the serum concentration, provides a window of opportunity for ailing cells to take up magnesium against a smaller concentration gradient. Nutrients taken up by cells after an IV infusion may eventually leak out again, but perhaps some healing takes place before they do. If cells are repeatedly “flooded” with nutrients, the improvement may be cumulative. It has been the author’s observation that some patients who receive a series of IV injections become progressively healthier. In these patients, the interval between treatments can be gradually increased, and eventually the injections are no longer necessary. Other patients require regular injections for an indefinite period of time in order to control their medical problems. This dependence on IV injections could conceivably result from any of the following: (1) a genetically determined impairment in the capacity to maintain normal intracellular nutrient concentrations;11 (2) an inborn error of metabolism that can be controlled only by maintaining a higher than normal concentration of a particular nutrient; or (3) a renal leak of a nutrient. 12 In some cases, continued IV therapy may be necessary because a disease state is too advanced to be reversible.