Thread by @GasBugZa

Next up is Lance Michell, who is giving a talk entitled 'Freshly squeezed - How should Vit C be served in ICU?'
#CCSSA2022 #critcare #FOAMcc

Vit C is famous for having curing scurvy back in the 1700s, but also for Paul Marik's controversial claim of its efficacy for sepsis in a paper in 2017, as part of a coctail of hydrocortisone, thiamine and Vit C.
doi.org/10.1016/j.ches…
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The activity of Vit C in the body includes activity as an antioxidant, helping reduce inflammation.
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Potential adverse effects of Vit C include:
-calcium oxalate nephropathy
-interference with blood glucose monitoring
doi.org/10.1097/MCC.00…

What does the evidence show?
Most trials look at either Vit C or in combination with thiamine and corticosteroids - most of the studies are unfortunately small.
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The major trial (LOVIT trial) came out this year.
It was a multinational prospective RCT recruiting patients with infection on a vasopressor, less than 24h in the ICU. They randomised to control or 50mg/kg infusion 6hrly for 4 days.
doi.org/10.1056/NEJMoa…
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It showed a worse mortality or persistent multiorgan failure in the Vit C group! The reasons for this have yet to be explored but it has thrown a spanner in the works.
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There is certainly compelling physiological evidence for the use of VitC, but its maybe not ready for primetime until dose adjusted studies show safety given the LOVIT trail. This is the personal opinion of the speaker.
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