PulmCrit- Metabolic sepsis resuscitation: the evidence behind Vitamin C

https://emcrit.org/pulmcrit/metabolic-sepsis-resuscitation/

mitochondria

Key knowledge here:
Vitamin C and Thiamine Vit B1 is not producable by human body but consumable.

Storage is limited and can be depleted in stress condition

In sepsis, vitamin C can be as low as undetectable in most of patient. A third of sepsis patient have low thiamine.

Vitamin C – required to produce cathecholamine
Thiamine – lack of thiamine can lead to wet beriberi. Mimic distrubutive shock

If we combine the lack of these two vitamins. Lead to profound shock

But we know, nobody measure it and it pass unnoticed.

Vitamin C and thiamine is quite safe. A lot of study and proved.

For time being no large and multicenter RCT (level I evident)

But nearly all of our current therapies for sepsis lack level-I evidence.

Multiple research have shown, reduce in vasopressor use, ventilatory support and mortality.

So far, we have HYPRESS, talk about role of hydrocortisone.

So Dr Marik combine these 3 things up = Dr Marik’s cocktail.

So far have a good outcome.

In conclusion : it’s safe, no harm to give. But not in guideline yet. Up to HOD.

Here the cocktails guys. IV not stir up. Hahaha.

HYPRESS

IV_HALL_shutterstock_528854752http://www.esicm.org/news-article/ARTICLE-REVIEW-hydrocortisone-severe-sepsis-hypress-Jan-2017

Basically this article discuss about hydrocortisone use in sepsis patient. Their hypothesis sepsis cause hyper-inflammatory responses and cause shock. So by giving hydrocortisone, by theory should reduce the morbidity and mortality because steroid reduce inflammation. But HYPRESS study not enough sample to came out with significant suggestion or recommendation. So they think, sepsis is not as simple as hyper-inflammation. For now, the use of hydrocortisone for sepsis patient still not a practical till further study.

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