Treating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring the quest for the magic elixir Journal Article


Authors: Obi, J.; Pastores, S. M.; Ramanathan, L. V.; Yang, J.; Halpern, N. A.
Article Title: Treating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring the quest for the magic elixir
Abstract: The administration of ascorbic acid (vitamin C) alone or in combination with thiamine (vitamin B1) and corticosteroids (VCTS) has recently been hypothesized to improve hemodynamics, end-organ function, and may even increase survival in critically ill patients. There are several clinical studies that have investigated the use of vitamin C alone or VCTS in patients with sepsis and septic shock or are ongoing. Some of these studies have demonstrated its safety and potential benefit in septic patients. However, many questions remain regarding the optimal dosing regimens and plasma concentrations, timing of administration, and adverse effects of vitamin C and thiamine. These questions exist because the bulk of research regarding the efficacy of vitamin C alone or in combination with thiamine and corticosteroids in sepsis is limited to a few randomized controlled trials, retrospective before-and-after studies, and case reports. Thus, although the underlying rationale and mechanistic pathways of vitamin C and thiamine in sepsis have been well described, the clinical impact of the VCTS regimen is complex and remains to be determined. This review aims to explore the current evidence and potential benefits and adverse effects of the VCTS regimen for the treatment of sepsis. © 2020 Elsevier Inc.
Keywords: clinical feature; review; placebo; drug efficacy; monotherapy; gastrointestinal symptom; drug hypersensitivity; intensive care unit; drug mechanism; vitamin supplementation; sepsis; ascorbic acid; drug metabolism; hydrocortisone; ascorbic acid deficiency; drug administration route; critical illness; vitamin blood level; randomized controlled trial (topic); nephrolithiasis; septic shock; glucosuria; combination drug therapy; vitamin c; thiamine; human; thiamine deficiency; levels; laboratory testing; hyperoxaluria; scurvy
Journal Title: Journal of Critical Care
Volume: 57
ISSN: 0883-9441
Publisher: W.B. Saunders Co.  
Date Published: 2020-06-01
Start Page: 231
End Page: 239
Language: English
DOI: 10.1016/j.jcrc.2019.12.011
PUBMED: 32061462
PROVIDER: scopus
DOI/URL:
Notes: J. Obi's last name and first initial are reversed on the original publication; Jennifer J. Yang verified per confirmation from author -- Review -- Source: Scopus
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MSK Authors
  1. Neil A Halpern
    126 Halpern
  2. Stephen Pastores
    166 Pastores
  3. Jennifer Ifeoma Obi
    2 Obi
  4. Jennifer Joyce Yang
    1 Yang