Adjuvant vitamin C in cardiac arrest patients undergoing renal replacement therapy: an appeal for a higher high-dose

Vitamin C dosing during continuous renal replacement therapy: The last word is not said!

“…We recently proposed higher vit C dosing in cardiac arrest patients who require continuous renal replacement therapy (CRRT). [1] In a reaction, Spoelstra-de Man et al . rebutted that increasing the vit C dose above 2 g/day during continuous veno-venous hemofiltration (CVVH) was unnecessary when normal plasma vit C concentrations are targeted.…”

Severe vitamin C deficiency associated with continuous renal replacement therapy: A case report

“…17 Some recommendations suggest avoiding supplementing >250 mg/ day to reduce the risk of nephrotoxic oxalate deposition in the kidneys, 9 whereas others contend that higher doses of supplementation are required to overcome the net negative balances induced by CRRT. 17 The European Society for Clinical Nutrition and Metabolism (ESPEN) clinical practice guidelines comment that patients receiving CRRT may develop severe micronutrient deficiencies and that vitamin C status should be monitored and supplemented based on serum levels and effluent losses, although they do not comment on specific dosage recommendations. 11,18 A patient developed a severe vitamin C deficiency after receiving prolonged CRRT despite receiving ascorbic acid supplementation of 450 mg/day in her parenteral nutrition (PN).…”

Dosing adjuvant vitamin C in critically ill patients undergoing continuous renal replacement therapy: We are not there yet!

“…Significant vit C deficiency was observed in 80% of patients subjected to various types of CRRT despite receiving a daily intravenous (IV) supplement of 500 to 1000 mg [2]. Therefore, high-dose (from 6 to 12 g) vit C substitution during CRRT seems justified [3].…”