An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
I have to admit the glucocorticoids are amongst my favorite medications that we use regularly in the ICU. Whether it be hydrocortisone, dexamethasone, or methylprednisolone, I have order sets built into my EMR with the dosing for the respective indications. The indications appear to be endless. Today, I am going to be discussing an article …
Continue reading Hydrocortisone for Severe Community-Acquired Pneumonia (CAP)
The concept of metabolic resuscitation has been around for several years. Unfortunately, the data for using ascorbic acid, thiamine, and glucocorticoids has not been as robust as we would like. There have been challenges replicating the miraculous data seen in the first trial in every subsequent trial performed after that. There have been numerous limitations …
Continue reading Hydroxocobalamin (Vitamin B12) for Septic Shock
Allow me to start off with a disclaimer. I favor cheap and readily available therapies over expensive therapeutics. There has been a lot of talk about Vitamin D and it's relationship with COVID-19. Honestly too much for me to get into. It seems as if there's something new every day. What we lack, though, is …
Continue reading Vitamin D for COVID-19: Are we missing a potential therapeutic?
Did you know that zinc is the second-most abundant trace metal in the human body? A quick reminder that iron comes in first place. Zinc is an essential component of protein structure and function. It enables gene transcription and is a "catalytic component of approximately 2000 enzymes" (Read, et al). Could we use zinc for …
Continue reading Zinc for Metabolic Resuscitation in Critical Illness
Bias alert. I am bullish on Vitamin C. Aren't things easier when you don't have to wonder these things? I digress. The article cited for this post was published in the journal Nutrition on 7/25/2020. Obviously, the title of the paper "Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19?" caught my attention. Hat …
Continue reading Vitamin C for COVID: Possible Prophylaxis & Adjunctive Therapy
Learning about the benefits of melatonin while creating my metabolic resuscitation lectures has been quite intriguing. The first time I was exposed to these beneficial antioxidant and anti-inflammatory effects was during a live lecture by Dr. Paul Marik. As of late, there have been three articles regarding utilizing melatonin in patients with COVID-19. Check here …
ADDENDUM 1/5/22: We have now been using dexamethasone for COVID-19 patients who require oxygen since summer of 2020. We have been mostly stuck on using the dose of 6mg per day in these patients simply because that's what the great authors of the RECOVERY trial group did. This isn't a dig at them, they did …
Continue reading Dexamethasone in COVID-19: Improving Survival
Image by Dr. Gizzy, @physiciandoodles on Instagram. This post is a work in progress regarding everything you need to know regarding administering high-dose intravenous (IV) Vitamin C (ascorbic acid) to your critically ill patient. I will continue to work on this post regarding IV vitamin c as well as metabolic resuscitation as time allows and …
Continue reading IV Vitamin C & Metabolic Resuscitation in Septic Shock: Ultimate Guide
Many think that the interest in IV thiamine in septic shock is a relatively novel idea after Paul Marik's paper was published in CHEST back in 2017. It actually goes a lot further than that. We've actually known that 20% of critically ill patients have a thiamine deficiency upon presentation to the ICU. More recent …
Continue reading IV Thiamine: Can it Help Critically Ill Septic Shock Patients?
How I use IV Vitamin C in my practice Since 2017, I have been providing the cocktail of intravenous (IV) vitamin c, thiamine, and stress dose steroids to my patients in septic shock. At my institution, we have complied many patients to whom we have given this regimen. We are looking to use this data …
Continue reading IV Vitamin C in Sepsis: Does it cause harm?