On a recent afternoon, she gestured with her thumb to the spot where the fluid, which was probably dextrose, a form of glucose, or sugar, was inserted. It is the only digit Ms. Jang, 61, has left. Doctors amputated most of her hands and both her legs below the knee after she was taken by ambulance from the clinic to New York Hospital Queens, racked with septic shock.
And although it is not certain that the infection resulted from her procedure at the clinic, Ms. Jang's fate sent a scare through the Korean and Chinese hubs of New York City, where the use of intravenous solutions to combat even mild illnesses is something of a norm, a practice imported from home.
Though the zip glucose imparts is similar to that from consuming a sports drink, according to doctors, in China, IV solutions are dispensed so freely to healthy people that there have been calls by the government to halt the practice and stark warnings of IV overuse there from international health organizations.
In New York, some pharmacies sell IV bags illegally over the counter with whispers not to tell any "Westerners," off-duty nurses go door-to-door offering IV pick-me-ups, and there are private walk-in clinics where, patients say, for less than $100 they get a drip hooked up on request, no questions asked. Patients and staff at clinics and pharmacies described the drips and how they are given, but on a visit to the clinic where Ms. Jang said she received her IV, a reporter was forbidden from seeing the room beyond the drawn curtain where, a receptionist said, the drips were administered.
When Jia Ling had a persistent cough this summer, she sought out IV treatment. "I took medicine, American medicine — it didn't work," said Ms. Ling, 28, a former kindergarten assistant who emigrated from China four years ago. At the Flushing clinic a friend recommended, she paid $80 for the treatment, sitting beside several other people on a couch, each hooked up to an IV drip. She does not know what the solution was. "They are professionals, I trust them," she said.
Beyond improper sale and administration of the solution, there are other inherent dangers, said Ray Macioci, the chairman of the New York City Pharmacists Society, including that it may mean a patient does not seek "good professional help to see what is actually the problem."
Many who turn to IVs are uninsured, drawn by the relatively low price for a treatment. And while intravenous infusions are regularly prescribed by doctors and performed by medical professionals in the United States, because of the risk of infection they are used with reserve, for patients suffering from dehydration or who are unable to eat, for example.
Doctors have leeway to decide when a drip should be used, but prescribing it to, say, take the edge off jet lag is not medically indicated, said Dr. Perry Pong, the chief medical officer of the Charles B. Wang Community Health Center, a nonprofit facility based primarily in Manhattan's Chinatown.
Fielding and refusing requests for IV infusion at the Wang center is routine, according to the medical staff.
In China, however, drips are so commonly prescribed that the country's national health organization started public awareness campaigns to try to limit the practice. According to the World Health Organization, China is among the countries that use the most intravenous treatments; in 2010, the last year for which data is available, the region averaged 4.18 injections per person per year; the world average is just 2.88. The W.H.O. estimates that over a half-million new cases of hepatitis B were contracted there that year because of unsafe injection practices, and more than 6,000 new cases of H.I.V.
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