The VITAMINS trial looking at IV Vitamin C didn’t pan out was not a positive study as it was conducted. It was surprising as intravenous (IV) Vitamin C in sepsis should help decrease vasopressor dose and duration. My contention with that study is that they took too long to initiate the study drug. A median time >25 hours, not including the time to arrive in the ICU. Sepsis management is expedient, you and I see it every day. Waiting over a day is not being expedient.
I’m seeing a benefit in my clinical practice by providing IV Vitamin C. I admit it’s a worthless as my opinion is on the grand scheme of evidence. When something doesn’t make sense from a results standpoint, you need to go back to the basics and wonder what happened. I have a post covering many things Vitamin C in Sepsis here.
Vitamin C Deficiency
Here are some things we absolutely know: 88% of patients in septic shock have hypovitaminosis C and 38% of septic shock patients have severe vitamin C deficiency. IV Vitamin C should help.
Vitamin C is a co-factor for endogenous catecholamine synthesis
What many of you may not know, and I’m here to help you understand why I’m so surprised by the findings of the VITAMINS trial, is that vitamin c is a co-factor to the creation of endogenous catecholamines. That means that without vitamin c, your body isn’t going to produce the appropriate amounts of vasopressors like dopamine, norepinephrine, and epinephrine.
It also is necessary for the production of vasopressin. It’s as simple as that. 38% of people will not produce appropriate endogenous catecholamines. The fact that administering exogenous vitamin c did not decrease time that the patients were receiving vasopressors in the study makes me wonder why. I am aware that there was a delay of >24 hours to start the therapies in the study but is there more I’m missing. Hopefully you can take some basic biochem away from this post as to why it should work (although it didn’t in the study).
A 🎩 tip to the authors.
Carr, A.C.; Shaw, G.M.; Fowler, A.A.; Natarajan, R. Ascorbate-dependent vasopressor synthesis: A rationale for vitamin C administration in severe sepsis and septic shock? Crit. Care 2015, 19, e418.
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