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High-dose vitamin C in critical illness shows mixed results. While some studies suggest harm in sepsis and COVID-19, others indicate benefits in cardiac surgery and burn patients, necessitating further research on optimal dosing.

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Area of Science:

  • Critical care medicine
  • Nutritional biochemistry
  • Pharmacology

Background:

  • Vitamin C (ascorbic acid) acts as an electron donor in numerous enzymatic reactions, suggesting potential therapeutic roles in critical illness.
  • Recent randomized controlled trials (RCTs) have investigated high-dose vitamin C in critically ill patients, yielding varied outcomes.

Purpose of the Study:

  • To review recent evidence on the efficacy and safety of vitamin C as an adjunctive treatment in critically ill patients.
  • To explore potential benefits in specific conditions like sepsis, COVID-19, and ischemia/reperfusion injury.

Main Methods:

  • Analysis of recent large randomized controlled trials (RCTs) in sepsis, COVID-19, cardiac surgery, and burn patients.
  • Review of studies examining vitamin C's effects on clinical outcomes, biomarkers, and physiological parameters.

Main Results:

  • Two large RCTs indicated potential harm with high-dose vitamin C in sepsis and COVID-19 patients.
  • Studies in cardiac surgery and burn patients reported improved outcomes, including reduced cardiac enzymes and decreased fluid requirements.
  • Vitamin C may benefit patients with ischemia/reperfusion injury, such as post-cardiac arrest or organ transplantation.

Conclusions:

  • Current evidence is conflicting, with potential harm in some populations and benefits in others.
  • Optimal timing, duration, and individualized dosing strategies for vitamin C in critical illness require further investigation.
  • Ensuring adequate basal vitamin C levels is recommended, but precise requirements remain undetermined.