Paul Marik may be onto something…. J. Teng, A. Pourmand, M. Mazer-Amirshahi, Vitamin C: The next step in sepsis management?, In Journal of Critical Care, Volume 43, 2018, Pages 230-234, ISSN 0883-9441,
Hey guys i’m eddie and this is my first ever journal – ish that i made for youtube the article that i’m going to talk about today is regarding the vitamin c now there’s a lot of talk about vitamin c because we’re dying for something new in sepsis and hopefully this is gonna be something that’s going to help out our patients from pretty much dying from a form of
Disease process to has up to a 50% mortality in patients without septic shock you know the only one that i’m talking about is free and the link is in the description box below it was published online in the journal of critical care in december it’s december right now 2017 and the section supposed to come out in print in february 2018 but we’re getting a head start
On this because it’s so cool the title of the article is vitamin c the next step in sepsis management a big hat tip to the people away in georgetown and george washington university for coming up with a study because researchers like depend on guys like you thank you very much for doing research and then i can very for me as a big disclaimer this big as being shy
In december 2017 so if you watch this video in the future data changes so we’ll make sure to keep up with the data and that’s the reason why i read so much my journal club ish is not a journal club it’s journal club ish so it’s not gonna be the in depth type of discussion one oh i want what i want to convey to you is basically the key points in this article and why
I think it’s cool and how it’s gonna change my practice now this is a shorter article i have a very short attention spans 5 pages but when you cut out all the figures and references and yeah check them all that it’s only like 3 and a half pages so it’s a quick read it’s free the link is below go and check out for yourself why am i excited about this article well
First of all it’s regarding patients who are in septic shock that’s my bread and water that’s what i do every day now the statistics on septic shock is that people who are in septic shock come up to a 50% mortality we need to cut that down we need to get better on this and there’s been a ton of medications and products that have basically failed so it’s vitamin c
The answer to all our puzzles maybe not maybe so but this is heading us in the right direction in addition to that as i mentioned any advancement with reverse sepsis management is gonna have you super exciting now my first contact and all honestly about vitamin c in sepsis management came from paul merrick study which i will also link in the description box below
So make sure you check that out like you basically use vitamin c thiamine and steroids to cleanse more we got significant e in his icy unit they kept tip to all those people as well for coming up with that study i’m not going to discuss all the intricacies of that paper in this and you know there’s a lot of controversy with regards to everything that transpired
Over there but hey i like it another reason why i’m such a fan of vitamin c is because it’s cheap now i’ve actually got the information for my particular shop which i’m not gonna go ahead and disconnect i will tell you compared to a lot of things we do in gacy you vitamin c is cheap cheap cheap cheap cheap cheap that’s why i can that’s why i want to succeed is
That’ll buy this from me perhaps but i wanted to succeed now starting off with the introduction to the article why did the authors want to pursue looking into vitamin c well we know that sepsis of the whole it’s not necessarily just a bacteria causing and causing a problem and causing an infection but it’s also the overbearing immune system actually harming the
Body in the process of fighting this particular infection it’s a huge inflammatory process that’s abnormal and it’s overly exaggerated in these patients now our sepsis bundles which basically include antibiotics in the first hour the 30 cc’s per kilogram of iv fluid resuscitation etc etc etc not a big target the inflammatory process the uber inflammatory process
That seen in sepsis in our patients also are antibiotics on some of them are bacterial saito and therefore costs destruction of these bacteria causing more inflammation on top of that so it’s just too much information we gotta find a way to bring that down and tone that down so we need to find a way to get this information and oxidative stress down to a manageable
Level and we honestly don’t have any therapy for it and there’s been numerous amounts of therapies that have been tried in the past all of it each is something up they just haven’t panned out and here’s a short list of things that have been tried out in the past i haven’t worked there are three key functions that vitamin c is supposed to have an effect on which
Helped us out in sepsis and patients who are septic shock the first one is that it’s an antioxidant the second one is that it helps produce these oppressors you know that stuff that we give to people yeah helps produce it endogenously and the third is that it helps out with this immune response and i’m holding up five fingers by let’s say three as an antioxidant
It helps produce big depressing cortisol and other catecholamines we need these three things have i haven’t seen helps produce this it all so much lisa a new system through iron & poby it prevents damage to sever their proteins it also maintains the integrity of dangled feed him which basically keeps the capillaries from anything keeps you from third spacing
It improves micro vascular profusion and the reduces inflammatory modulators therefore also keeping the integrity together of that epithelium with regards to be suppressors synthesis we know that vitamin c is a cool factor needed for the production of vasopressin you know that stuff that we give to people or exogenous mean well now with vitamin c we can hope the
Body produces naturally it also has a cofactor for other other catecholamine sentences we have a body of data that shows that your endogenous vasopressin synthesis in sepsis decreases so when the addition of vitamin c theoretically this should allow for more production of vasopressin it is knowing that the vitamin c levels in the body i guess if i go like this yeah
Vitamin c that was in the body decrease as somebody goes into shock or gets very sick vitamin c is required in two steps to produce catecholamines endogenously it’s also necessary in the production of dopamine it also modulates alpha receptors and the beta receptors which are the things that we’re targeting with such medications as a nephron and norepinephrine and
Epinephrine when we’re treating patients who are in shock the third component that i mentioned was vitamin c’s effect on immune function three things that vitamin c helps to kill bugs first it improves chemotaxis second supports live esthetical information proliferation sir it assists in the oxidative which fitted killing of bacteria by leukocytes three biggie’s right
There now you might say to me eddie this sounds great i love all this stuff sign me up for vitamin c but where’s the data well there’s not a lot of data right now and that’s part of the problem behind all this there are five studies and all of them have a very small sample size in my personal practice i have an n of one and they didn’t make it well but i don’t know
Whether that was just the way i secured the patient or it happened to be the vitamin c i’m not sure but here’s the data as i mentioned palmieri study with a penile 42 is now the most substantial data that we have with regards to treating people with vitamin c my own addition to that think that these people also kind of stressed those stairways sort of speak and they
Also got clammy you know poor limitation using vitamin c as i mentioned is that there’s no data well there’s no randomized double-blind placebo trial you know those big sexy studies that are multi centers and all that that just doesn’t exist so hopefully in the near future we’re gonna have some of that data to help substantiate our desire to use not my seen the hd
You also all studies that or you have different doses different intervals of tightening people getting vitamin c and they’re just not you just can’t put them in the same box but if you’re into research this could be a particular location or a particular study that you can do at your shop that will be very different from very helpful to the world of critical care
So the conclusion of these authors with regards to the study i’m gonna read this to you is that there’s a lack of large multicenter randomized controlled trials investigating the utility of vitamin c in treating sepsis which these doubt as to the strength of the currently available data and as i for efficacy and effectiveness and treating patients in other words
Further evidence is required before can be recently used as an adjuvant treatment of sepsis well hopefully we’re gonna get this sometime soon lastly how does it affect my practice well i would love to use it i know how much it costs it’s not expensive at all compared to a lot of other things that we give to patients dimes see some more data i’ve actually tried as
I mentioned before the americorps call on a patient was in septic shock refractory to everything and in they did well i don’t know it was because of the way i were so stated a number there or their protoplasm i have no idea but they got over the whole septic shock insole and one is worse than this basically but i’m excited to try something new so i hope that you all
Wear something from this article that i could be reviewed i hope i didn’t go too fast i also hope i didn’t take very long cuz i don’t know how on the stairs okay but nevertheless take the subscribe link below and check out the articles yourself i definitely recommend you doing that because that’s the way that you get the most out of this data and once again have a
Hat tip and thumbs up to the to the authors because they’re doing research and i’m just reading things and sharing it all with you thanks a lot and also i got a lot of subscribers they jumped up a significant amount from the last time that i posted a video so thank you very much to all your subscribers and hopefully these articles will be very exactly and any more of these videos take
Transcribed from video
IV Vitamin C/Ascorbic Acid in the ICU (Journal Club-ish) By eddyjoemd
