Application of vitamin C in sepsis

doi:10.3877/cma.j.issn.2096-1537.2020.031

Abstract

Abstract:

Sepsis is a leading cause of morbidity and mortality in critically ill patients. Most patients with sepsis had hypovitaminosis C or vitamin C deficiency, which probably caused by increased metabolic consumption due to critically illness-induced oxidative stress and reduced recycling of dehydroascorbic acid. Therefore, repletion of vitamin C may be an effective adjuvant therapy in sepsis. We review the mechanism, dosage and usage, potential side effects, combination with others and the current clinical researches of vitamin C in sepsis management, to deepen the clinicians′ understanding the role of vitamin C in sepsis treatment.

Key words: Sepsis, Vitamin C, Improvements

Qingquan Lyu, Xiaohua Gu, Yingming Lyu, Ruiqiang Zheng. Application of vitamin C in sepsis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(01): 104-108.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2020.031

https://icu.cma-cmc.com.cn/EN/Y2020/V06/I01/104

References 47

1	Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations [J]. Am J Respir Crit Care Med, 2016, 193 (3): 259-272.
2	Carr AC, Rosengrave PC, Bayer S, et al. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes [J]. Crit Care, 2017, 21 (1): 300.
3	Spoelstra-de Man AME, Elbers PWG, Oudemans-Van Straaten HM. Vitamin C: should we supplement? [J]. Curr Opin Crit Care, 2018, 24 (4): 248-255.
4	Berger MM, Oudemans-van Straaten HM. Vitamin C supplementation in the critically ill patient [J]. Curr Opin Clin Nutr Metab Care, 2015, 18 (2): 193-201.
5	May JM, Harrison FE. Role of vitamin C in the function of the vascular endothelium [J]. Antioxid Redox Signal, 2013, 19 (17): 2068-2083.
6	Oudemans-van Straaten HM, Spoelstra-de Man AM, de Waard MC. Vitamin C revisited [J]. Crit Care, 2014, 18 (4): 460.
7	Anand T, Skinner R. Vitamin C in burns, sepsis, and trauma [J]. J Trauma Acute Care Surg, 2018, 85 (4): 782-787.
8	Fisher BJ, Kraskauskas D, Martin EJ, et al. Attenuation of sepsis-induced organ injury in mice by vitamin C [J]. JPEN J Parenter Enteral Nutr, 2014, 38 (7): 825-839.
9	Marik PE. ″Vitamin S″ (Steroids) and Vitamin C for the Treatment of Severe Sepsis and Septic Shock! [J]. Crit Care Med, 2016, 44 (6): 1228-1229.
10	Teng J, Pourmand A, Mazer-Amirshahi M. Vitamin C: The next step in sepsis management? [J]. J Crit Care, 2018, 43: 230-234.
11	Koekkoek WA, van Zanten AR. Antioxidant vitamins and trace elements in critical illness [J]. Nutr Clin Pract, 2016, 31 (4): 457-474.
12	Mo SJ, Son EW, Rhee DK, et al. Modulation of TNF-alpha-induced ICAM-1 expression, NO and H₂O₂ production by alginate, allicin and ascorbic acid in human endothelial cells [J]. Arch Pharm Res, 2003, 26 (3): 244-251.
13	Carcamo JM, Pedraza A, Borquez-Ojeda O, et al. Vitamin C suppresses TNF alpha-induced NF kappa B activation by inhibiting I kappa B alpha phosphorylation [J]. Biochemistry, 2002, 41 (43): 12995-13002.
14	Mohammed BM, Fisher BJ, Kraskauskas D, et al. Vitamin C: a novel regulator of neutrophil extracellular trap formation [J]. Nutrients, 2013, 5 (8): 3131-3151.
15	Gao YL, Lu B, Zhai JH, et al. The parenteral vitamin C improves sepsis and sepsis-induced multiple organ dysfunction syndrome via preventing cellular immunosuppression [J]. Mediators Inflamm, 2017, 2017: 4024672.
16	May JM, Qu ZC, Meredith ME. Mechanisms of ascorbic acid stimulation of norepinephrine synthesis in neuronal cells [J]. Biochem Biophys Res Commun, 2012, 426 (1): 148-152.
17	Dillon PF, Root-Bernstein RS, Lieder CM. Antioxidant-independent ascorbate enhancement of catecholamine-induced contractions of vascular smooth muscle [J]. Am J Physiol Heart Circ Physiol, 2004, 286 (6): H2353-2360.
18	Carr AC, Shaw GM, Fowler AA, et al. Ascorbate-dependent vasopressor synthesis: a rationale for vitamin C administration in severe sepsis and septic shock? [J]. Crit Care, 2015, 19: 418.
19	Russell JA. Bench-to-bedside review: vasopressin in the management of septic shock [J]. Crit Care, 2011, 15 (4): 226.
20	Wu F, Wilson JX, Tyml K. Ascorbate protects against impaired arteriolar constriction in sepsis by inhibiting inducible nitric oxide synthase expression [J]. Free Radic Biol Med, 2004, 37 (8): 1282-1289.
21	Pleiner J, Mittermayer F, Schaller G, et al. Inflammation-induced vasoconstrictor hyporeactivity is caused by oxidative stress [J]. J Am Coll Cardiol, 2003, 42 (9): 1656-1662.
22	Lelubre C, Vincent JL. Mechanisms and treatment of organ failure in sepsis [J]. Nat Rev Nephrol, 2018, 14 (7): 417-427.
23	Mantzarlis K, Tsolaki V, Zakynthinos E. Role of oxidative stress and mitochondrial dysfunction in sepsis and potential therapies [J]. Oxid Med Cell Longev, 2017, 2017: 5985209.
24	Kc S, Carcamo JM, Golde DW. Vitamin C enters mitochondria via facilitative glucose transporter 1 (Glut1) and confers mitochondrial protection against oxidative injury [J]. FASEB J, 2005, 19 (12): 1657-1667.
25	Belsky JB, Wira CR, Jacob V, et al. A review of micronutrients in sepsis: the role of thiamine, l-carnitine, vitamin C, selenium and vitamin D [J]. Nutr Res Rev, 2018, 31 (2): 281-290.
26	Fisher BJ, Kraskauskas D, Martin EJ, et al. Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid [J]. Am J Physiol Lung Cell Mol Physiol, 2012, 303 (1): L20-32.
27	Fowler AA 3rd, Syed AA, Knowlson S, et al. Phase Ⅰ safety trial of intravenous ascorbic acid in patients with severe sepsis [J]. J Transl Med, 2014, 12: 32.
28	Padayatty SJ, Sun H, Wang Y, et al. Vitamin C pharmacokinetics: implications for oral and intravenous use [J]. Ann Intern Med, 2004, 140 (7): 533-537.
29	Long CL, Maull KI, Krishnan RS, et al. Ascorbic acid dynamics in the seriously ill and injured [J]. J Surg Res, 2003, 109 (2): 144-148.
30	Gottschlich MM, Warden GD. Vitamin supplementation in the patient with burns [J]. J Burn Care Rehabil, 1990, 11 (3): 275-279.
31	Zabet MH, Mohammadi M, Ramezani M, et al. Effect of high-dose Ascorbic acid on vasopressor′s requirement in septic shock [J]. J Res Pharm Pract, 2016, 5 (2): 94-100.
32	Tanaka H, Matsuda T, Miyagantani Y, et al. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study [J]. Arch Surg, 2000, 135 (3): 326-331.
33	Wang Y, Lin H, Lin BW, et al. Effects of different ascorbic acid doses on the mortality of critically ill patients: a meta-analysis [J]. Ann Intensive Care, 2019, 9 (1): 58.
34	Buehner M, Pamplin J, Studer L, et al. Oxalate nephropathy after continuous infusion of high-dose vitamin C as an adjunct to burn resuscitation [J]. J Burn Care Res, 2016, 37 (4): e374-379.
35	Carr A, Frei B. Does vitamin C act as a pro-oxidant under physiological conditions? [J]. FASEB J, 1999, 13 (9): 1007-1024.
36	Hager DN, Martin GS, Sevransky JE, et al. Glucometry when using vitamin C in sepsis: a note of caution [J]. Chest, 2018, 154 (1): 228-229.
37	Wischmeyer PE. Nutrition therapy in sepsis [J]. Crit Care Clin, 2018, 34 (1): 107-125.
38	Nandhabalan P, Ioannou N, Meadows C, et al. Refractory septic shock: our pragmatic approach [J]. Crit Care, 2018, 22 (1): 215.
39	Donnino MW, Andersen LW, Chase M, et al. Randomized, double-blind, placebo-controlled trial of thiamine as a metabolic resuscitator in septic shock: a pilot study [J]. Crit Care Med, 2016, 44 (2): 360-367.
40	Shin TG, Kim YJ, Ryoo SM, et al. Early vitamin C and thiamine administration to patients with septic shock in emergency departments: propensity score-based analysis of a before-and-after cohort study [J]. J Clin Med, 2019, 8 (1): 102.
41	Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock [J]. N Engl J Med, 2018, 378 (9): 797-808.
42	Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus fludrocortisone for adults with septic shock [J]. N Engl J Med, 2018, 378 (9): 809-818.
43	Barabutis N, Khangoora V, Marik PE, et al. Hydrocortisone and ascorbic acid synergistically prevent and repair lipopolysaccharide-induced pulmonary endothelial barrier dysfunction [J]. Chest, 2017, 152 (5): 954-962.
44	Azari O, Kheirandish R, Azizi S, et al. Protective effects of hydrocortisone, vitamin C and E alone or in combination against renal ischemia-reperfusion injury in rat [J]. Iran J Pathol, 2015, 10 (4): 272-280.
45	Lamarche J, Nair R, Peguero A, et al. Vitamin C-induced oxalate nephropathy [J]. Int J Nephrol, 2011, 2011: 146927.
46	Marik PE, Khangoora V, Rivera R, et al. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study [J]. Chest, 2017, 151 (6): 1229-1238.
47	Li J. Evidence is stronger than you think: a meta-analysis of vitamin C use in patients with sepsis [J]. Crit Care, 2018, 22 (1): 258.

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