Vitamin C: The next step in sepsis management?


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Abstract

Sepsis is a life-threatening medical condition, affecting approximately 26 million people worldwide every year. The disease is a continuum, marked by dysregulated inflammation and hemodynamic instability leading to shock, multi-system organ dysfunction, and death. Over the past decades, there has been a focus on the early identification and treatment of sepsis primarily with bundled and goal directed therapy. Despite these advances, morbidity and mortality has remained high, prompting investigation into novel therapies. Vitamin C is a water-soluble vitamin that plays a role in mediating inflammation through antioxidant activities and is also important in the synthesis of cortisol, catecholamines, and vasopressin, which are key mediators in the disease process. Emerging evidence provides cursory data in support of the administration of vitamin C in addition to standard therapy to ameliorate the effects of inflammation and improve hemodynamic stability in patients with sepsis and septic shock; however, further evidence is needed to support this practice. This review discusses the physiologic role of vitamin C as well as the recent literature and evidence for the use of vitamin C in patients presenting with sepsis.Highlights:Sepsis is a life threatening condition marked by dysregulated inflammation and hemodynamic instability leading to shock, multiple organ dysfunction, and death.Currently, the mainstay of sepsis treatment is directed at early identification and treatment of infection, source control when applicable, as well as reversing hemodynamic instability.There have been several investigations into potential therapies for sepsis using targeted adjuvant therapies, however many of have failed to improve clinical outcomes in the treatment of sepsis.Vitamin C has been hypothesized to be a cost-effective and novel adjuvant therapy that can be used to ameliorate the effects of inflammation and oxidative stress in sepsis.We discuss the role of Vitamin C as an antioxidant, in vasopressor synthesis, in immune function, and review detail recent studies in sepsis.

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