Update on vitamin C administration in critical illness

Area of Science:

• Critical Care Medicine
• Nutritional Biochemistry
• Pharmacology

Background:

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
• Intravenous vitamin C has emerged as a potential adjunctive therapy for sepsis.
• Previous research has yielded mixed results regarding its efficacy.

Purpose of the Study:

• To review and synthesize findings from recent studies on intravenous vitamin C in sepsis.
• To provide perspectives for future research directions.

Main Methods:

• Network meta-analysis of sepsis trials involving intravenous vitamin C (6 g/day) with or without thiamine and/or hydrocortisone.
• Scoping review of preclinical investigations and harm assessments of high-dose intravenous vitamin C.
• Analysis of a Gram-negative sheep model assessing mega-dose vitamin C effects on kidney function.

Main Results:

• Network meta-analysis did not prove that intravenous vitamin C, thiamine, hydrocortisone, or combinations reduce long-term mortality.
• A component meta-analysis suggested a possible association between high-dose (>6 g/day) and very-high dose (>12 g/day) vitamin C and decreased mortality, albeit with low certainty.
• Preclinical studies indicate safety of mega-doses (50-100 g/day) and demonstrated improved kidney function in a sheep model with mega-dose administration (150 g/day equivalent).

Conclusions:

• The precise role of intravenous vitamin C in critically ill patients with sepsis remains undetermined.
• Efficacy may be dose-dependent, with preclinical data supporting the investigation of very high or mega doses in clinical trials.