Multiple organ dysfunction dramatically improving with the infusion of vitamin C: more support for the persistence of scurvy in our “welfare” society

Abstract

Sir: We report a case of severe end-stage scurvy mimicking multiple organ dysfunction. In humans deprived of ascorbic acid the deficiency disease scurvy develops insidiously over months [1] and can then become life-threatening as illustrated in our observation.A 75-year old retired administrator with a past history of diabetes and ischemic heart disease was admitted to our intensive care unit for acute respiratory failure, edema of the legs, and extensive purpuric lesions. He had already been examined because of anemia, development of bruises on the legs and abdomen, and repeated epistaxis without any abnormality of the clotting tests. This anemia was not related to low plasmatic concentrations of folic acid, vitamin B 12 , erythropoietin, iron, zinc, selenium, or transferrin. At admission the patient appeared conscious but weak; his blood pressure was 80/60 mmHg, pulse was 110/min, respiration 30/min, and central venous pressure 20 mmHg. His body temperature was 36.8 C. The patient was cyanosed with pulmonary edema. Confluent purpuric plaques extended from the legs to the perineum and the flanks, but no lesions were observed on the hands, feet, or face. Laboratory tests were normal with the exception of PaO 2 [45 mmHg (FIO 2 1)], creatininemia (295 mmol/l), white-cell count (3100/mm 3 ), and hemoglobin (7.5 g/dl). Electrocardiography showed an auricular fibrillation. An echocardiogram revealed a preserved ejection fraction (62 %). Radiography showed enlargement of the heart. The patient was infused with dobutamine (up to 15 mg/kg per minute) with a moderate effect on mean arterial pressure (+ 3 %) and central venous pressure (±5 %).

Effect of high-dose Ascorbic acid on vasopressor′s requirement in septic shock

“…Severe ascorbic acid deficiency (serum ascorbate level <27 μmol/L) was reported in critically ill patients. [ 15 16 25 26 27 ] Up to 3000 mg/day, ascorbic acid was needed to normalize the plasma level of ascorbic acid (68 μmol/L) in these patients. [ 28 ] Ascorbic acid deficiency was not prevented by the use of parenteral nutrition containing ascorbic acid in critically ill patients and most patients required high dose of this nutrient.…”

“…Intravenous ascorbic acid improved cardiovascular functioning and decreased requirement for catecholamine administration in a patient with septic shock. [ 25 ] In another case with typical symptoms of scurvy and fluid-resistant severe orthostatic hypotension, intravenous ascorbic acid improved the patients’ hemodynamic status within 24 h after its administration.…”

Ascorbate-dependent vasopressor synthesis: a rationale for vitamin C administration in severe sepsis and septic shock?

“…Cases of scurvy, the clinical presentation of severe ascorbate deficiency, have been reported in critically ill patients in intensive care (Table 1 ) [ 34 – 36 ]. One case presented with multiple organ dysfunction and the intravenous administration of ascorbate resulted in improved cardiovascular functioning within 24 h, particularly increased arterial pressure, decreased heart rate, normalised central venous pressure and a decreased need for catecholamines [ 35 ]. Another case exhibited typical symptoms of scurvy as well as severe orthostatic hypotension that failed to respond to fluids [ 36 ].…”

Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

“…While scurvy is relatively rare nowadays, it has not disappeared altogether. A number of case reports have described patients with overt scurvy in diverse hospital settings, including ICUs [13,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81]. Furthermore, even though clinical scurvy is rare, very low vitamin C plasma levels, such as those found in scurvy patients, are not uncommon in hospitals.…”