Any Role of High-Dose Vitamin C for Septic Shock in 2021?

• Type of Material: Article
• Authors: Ankita Agarwal, Emory University; David N Hager, Johns Hopkins University; Jonathan Sevransky, Emory University
• Language: English
• Date: 2021-10-01
• Publisher: THIEME MEDICAL PUBL INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 The Author(s). Rights managed by Thieme.
• Final Published Version (URL): http://dx.doi.org/10.1055/s-0041-1733986
• Title of Journal or Parent Work: SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE
• Volume: 42
• Issue: 05
• Start Page: 672
• End Page: 682
• Keywords: vitamin C; ACUTE RESPIRATORY-FAILURE; Life Sciences & Biomedicine; SKELETAL-MUSCLE; NF-KAPPA-B; ascorbic acid; Critical Care Medicine; Respiratory System; General & Internal Medicine; septic shock; HAT Rx; OXALATE NEPHROPATHY; Science & Technology; CRITICALLY-ILL PATIENTS; ENDOTHELIAL-CELLS; L-ASCORBIC-ACID; DEHYDROASCORBIC ACID; SEPSIS; resuscitation; sepsis; ACID-INDUCED HEMOLYSIS

Abstract

While the use of vitamin C as a therapeutic agent has been investigated since the 1950s, there has been substantial recent interest in the role of vitamin C supplementation in critical illness and particularly, sepsis and septic shock. Humans cannot synthesize vitamin C and rely on exogenous intake to maintain a plasma concentration of approximately 70 to 80 μmol/L. Vitamin C, in healthy humans, is involved with antioxidant function, wound healing, endothelial function, and catecholamine synthesis. Its function in the human body informs the theoretical basis for why vitamin C supplementation may be beneficial in sepsis/septic shock. Critically ill patients can be vitamin C deficient due to low dietary intake, increased metabolic demands, inefficient recycling of vitamin C metabolites, and loss due to renal replacement therapy. Intravenous supplementation is required to achieve supraphysiologic serum levels of vitamin C. While some clinical studies of intravenous vitamin C supplementation in sepsis have shown improvements in secondary outcome measures, none of the randomized clinical trials have shown differences between vitamin C supplementation and standard of care and/or placebo in the primary outcome measures of the trials. There are some ongoing studies of high-dose vitamin C administration in patients with sepsis and coronavirus disease 2019; the majority of evidence so far does not support the routine supplementation of vitamin C in patients with sepsis or septic shock.