Title: Intravenous Ascorbic Acid (Vitamin C) Dose Needed in Critically Ill Patients with Sepsis and Septic Shock Post Cardiac Surgeries

Authors: Yousry El Said Rizk, Ahmed Hamdy Abd Al Rahman, Mohammed Ahmed El Gazzar, Mahmoud Muhammed Abd Al Hafeith Jaber

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.148

Abstract

Introduction: Sepsis, a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection, is a major public health concern, accounting for more than $20 billion (5.2%) of total US hospital costs in 2011.

Sepsis is a life-threatening systemic inflammatory response that can result in multi-organ dysfunction and intractable hypotension. In critically ill patients, severe sepsis and septic shock are known as the main causes of mortality. Adequate fluid resuscitation, infection control, cardiovascular and respiratory supports are recommended for the management of severe sepsis and septic shock.

Effects of ascorbic acid on hemodynamic parameters were evaluated in nonsurgical critically ill patients in limited previous studies. High-dose ascorbic acid in patients with burn injury decreased fluid and vasopressors’ requirements. Also, in patients with severe sepsis, high-dose intravenous ascorbic acid improved hemodynamic parameters.[2]

Benha University Hospitals in the academic year of 2017. Patients were divided into 3 groups:

  • Group 1: Control (conventional management; IV fluids + antibiotics + vasopressors
  • Group 2: 3 grams/day.
  • Group 3: 6 grams/day.

Conclusion: We suggested that the early use of intravenous vitamin C may prove to be effective in preventing progressive organ dysfunction including acute kidney injury and reducing the mortality of patients with severe sepsis and septic shock. This inexpensive and readily available intervention has the potential to reduce the global mortality from sepsis.

References

  1. Singer, M., et al., The third international consensus definitions for sepsis and septic shock (sepsis-3). Jama, 2016. 315(8): p. 801-810.
  2. Zabet, Mohadeseh Hosseini, et al. "Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock." Journal of research in pharmacy practice 5.2 (2016): 94.
  3. Dellinger, R. Phillip, et al. "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012." Intensive care medicine 39.2 (2013): 165-228.
  4. Berger, Mette M. "Vitamin C requirements in parenteral nutrition."  Gastroenterology 137.5 (2009): S70-S78.
  5. Johnston, CAROL S., FRANCENE M. Steinberg, and ROBERT B. Rucker. "Ascorbic acid." Handbook of vitamins 4 (2007): 490-510.
  6. Honore, Patrick M., et al. "Adjuvant vitamin C treatment in sepsis—how many oranges a day keep (vasopressor-dependent) septic shock away?." Journal of thoracic disease 8.9 (2016): E993.

Corresponding Author

Mahmoud Muhammed Abd Al Hafeith Jaber

Cardiothoracic Surgery Head of Critical Care Department Faculty of Medicine Benha University