Vitamin C Administration in Critical Care Management

Vitamin C, or ascorbic acid, plays a central role in critical care through its antioxidant, anti-inflammatory and co-enzyme functions. Critically ill patients—particularly those with sepsis or septic shock—often develop profound hypovitaminosis C despite standard nutritional support, owing to accelerated metabolic consumption and renal losses. This deficiency exacerbates oxidative damage, endothelial dysfunction and dysregulated immune responses. Intravenous administration of high-dose vitamin C has been proposed to restore physiological levels rapidly, support catecholamine synthesis, reduce vasopressor requirements and improve microcirculatory flow. Dosing regimens range from fixed high-dose protocols to weight-based infusions up to 100 mg kg⁻¹ day⁻¹, initiated early in the course of critical illness. While initial trials reported improvements in organ failure scores and shorter durations of vasopressor use, effects on mortality remain heterogeneous and may depend on timing, dosage and patient selection. Safety concerns at supraphysiological concentrations—such as potential pro-oxidant effects and oxalate nephropathy—underscore the need for precise risk–benefit assessments. Ongoing large-scale randomised trials seek to clarify optimal administration strategies, identify subgroups most likely to benefit and integrate vitamin C into evidence-based bundles for sepsis and acute respiratory failure worldwide.

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Vitamin C Administration in Critical Care Management publication trend

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Technical terms

Sepsis: A life-threatening organ dysfunction caused by a dysregulated host response to infection.

Septic shock: A severe subset of sepsis characterised by persistent hypotension requiring vasopressor support and elevated lactate.

SOFA score: Sequential Organ Failure Assessment, a tool for quantifying the extent and progression of organ dysfunction in critically ill patients.

Vasopressor: A pharmacological agent that constricts blood vessels to elevate arterial pressure in hypotensive states.

Acute respiratory distress syndrome (ARDS): An acute inflammatory lung injury leading to increased vascular permeability, severe hypoxaemia and respiratory failure.

Trial sequential analysis: A statistical method applied to cumulative meta-analyses to adjust for random errors and control false-positive results.

References

1. The outcome of IV vitamin C therapy in patients with sepsis or septic shock: a meta-analysis of randomized controlled trials. Critical Care (2023).
2. Vitamin C: Rationale for Its Use in Sepsis-Induced Acute Respiratory Distress Syndrome (ARDS). Antioxidants (2024).
3. Intravenous vitamin C monotherapy in critically ill patients: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Annals of Intensive Care (2023).
4. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Critical Care (2017).
5. Vitamin C revisited. Critical Care (2014).
6. Ascorbate-dependent vasopressor synthesis: a rationale for vitamin C administration in severe sepsis and septic shock?. Critical Care (2015).
7. Randomized Clinical Trial of Antioxidant Therapy Patients with Septic Shock and Organ Dysfunction in the ICU: SOFA Score Reduction by Improvement of the Enzymatic and Non-Enzymatic Antioxidant System. Cells (2023).