• acute renal failure
• adult
• critical care
• fluids‐electrolytes/acid‐base
• minerals/trace elements
• renal disease
• vitamins

• Humans
• Intensive Care Units
• Nutritional Support/methods
• Critical Illness/therapy
• Renal Replacement Therapy/methods
• Nutritional Requirements
• Critical Care/methods
• Nutritional Status
• Acute Kidney Injury/therapy

• critical illness
• inflammation
• micronutrients
• nutrition
• oxidative stress

• Humans
• Critical Illness/therapy
• Micronutrients/deficiency
• Critical Care/methods
• Nutritional Status
• Nutritional Requirements
• Selenium/deficiency
• Selenium/administration & dosage

• Acute kidney injury
• Heart failure
• Immunity
• Inflammation
• Intestinal failure
• Refeeding syndrome
• Sepsis

• Humans
• Micronutrients/blood
• Critical Illness
• Oxidative Stress
• Antioxidants/metabolism
• Acute Disease
• Nutritional Requirements
• Trace Elements/blood
• Inflammation
• Nutritional Status
• Vitamins/blood
• Biomarkers/blood

• Humans
• Sepsis/drug therapy
• Sepsis/blood
• Male
• Female
• Middle Aged
• Aged
• Oxidative Stress/drug effects
• Vitamin B 6/therapeutic use
• Endothelin-1/blood
• Tumor Necrosis Factor-alpha/blood
• Interleukin-6/blood
• Acute Kidney Injury/drug therapy
• Acute Kidney Injury/prevention & control
• Interleukin-8/blood
• Superoxide Dismutase/blood
• Kidney/drug effects
• Kidney/metabolism
• Blood Urea Nitrogen
• Malondialdehyde/blood
• Creatinine/blood

• B-vitamins
• Copper
• Deficiency
• Diagnosis
• Iron
• Monitoring
• Prescription
• Selenium
• Thiamin
• Trace elements
• Vitamin
• Vitamins-A- C-D- E- K
• Zinc

• Humans
• Micronutrients
• Trace Elements
• Vitamins
• Consensus
• Databases, Factual

• pediatrics
• continuous rrt
• indirect calorimetry
• nutrition
• acute kidney failure

• Humans
• Child
• Continuous Renal Replacement Therapy
• Consensus
• Critical Illness/therapy
• Acute Kidney Injury/therapy
• Nutritional Status

• continuous renal replacement therapy
• critical care
• intensive care unit
• vitamin C

• Female
• Humans
• Continuous Renal Replacement Therapy
• Critical Illness/therapy
• Ascorbic Acid Deficiency/complications
• Ascorbic Acid/therapeutic use
• Renal Replacement Therapy
• Acute Kidney Injury/therapy

• Acute kidney injury
• Micronutrient
• Micronutrient loss
• Renal replacement therapy
• Trace element
• Vitamin

• Humans
• Trace Elements
• Micronutrients
• Continuous Renal Replacement Therapy
• Vitamins
• Selenium
• Renal Replacement Therapy
• Acute Kidney Injury/therapy
• Critical Illness/therapy

• Ascorbic acid
• Critical care
• Infection
• Sepsis
• Septic shock
• Vitamin C

• AKI
• CRRT
• G6PD
• High-dose vitamin
• No adverse effects
• Other side effects
• Safe
• Septic shock
• Vitamin inducing AKI

• Continous renal replacement therapy
• critically ill patients
• micronutrient
• trace element
• vitamin

Previous randomized trials of vitamin C, hydrocortisone, and thiamine on sepsis were limited by short-term vitamin C administration, heterogeneous populations, and the failure to evaluate each component’s effect. The purpose of this study was to determine whether vitamin C alone for ≥ 5 days or in combination with corticosteroids and/or thiamine was associated with decreased mortality across the sepsis population and subpopulation.

Nationwide population-based study conducted using the Korean National Health Insurance Service database. A total of 384,282 adult patients with sepsis who were admitted to the intensive care unit were enrolled from January 2017 to December 2019. The primary outcome was hospital mortality, while the key secondary outcome was 90-day mortality.

The mean [standard deviation] age was 69.0 [15.4] years; 57% were male; and 36,327 (9%) and 347,955 did and did not receive vitamin C, respectively. After propensity score matching, each group involved 36,327 patients. The hospital mortality was lower by − 0.9% in the treatment group (17.1% vs 18.0%; 95% confidence interval, − 1.3 to − 0.5%; p < 0.001), a significant but extremely small difference. However, mortality decreased greater in patients who received vitamin C for ≥ 5 days (vs 1–2 or 3–4 days) (15.8% vs 18.8% vs 18.3%; p < 0.001). Further, vitamin C was associated with a lower hospital mortality in patients with older age, multiple comorbidities, pneumonia, genitourinary infection, septic shock, and mechanical ventilation. Consistent findings were found for 90-day mortality. Moreover, vitamin C alone or in combination with thiamine was significantly associated with decreased hospital mortality.

Intravenous vitamin C of ≥ 5 days was significantly associated with decreased hospital and 90-day mortality in sepsis patients. Vitamin C combined with corticosteroids and/or thiamine in specific sepsis subgroups warrants further study.

The online version contains supplementary material available at 10.1186/s13054-021-03872-3.

• Ascorbic acid
• Mortality
• Sepsis
• Septic shock
• Steroids
• Thiamine

• adsorption
• carnitine
• effluent losses
• metabolism
• micronutrient deficiency
• selenium
• thiamine
• vitamin c

• Humans
• Micronutrients
• Renal Replacement Therapy
• Thiamine
• Trace Elements
• Vitamins/therapeutic use

• minerals/trace elements
• neonates
• parenteral nutrition
• pediatrics
• public policy
• vitamins

• Critically ill children
• Micronutrients
• Nutrition
• Paediatric intensive care
• Vitamins

• Child
• Child Nutritional Physiological Phenomena
• Child, Preschool
• Critical Illness
• Female
• Humans
• Infant
• Male
• Micronutrients/blood
• Nutritional Requirements
• Nutritional Status

• ICA-CL-2016-02-001 Department of Health

• critical illness
• food intake
• nutrition rehabilitation
• oral nutrition
• quality of care

• Critical Care/standards
• Critical Illness/rehabilitation
• Energy Intake
• Humans
• Intensive Care Units
• Length of Stay
• Malnutrition/prevention & control
• Nutrition Assessment
• Nutritional Status
• Quality of Health Care/organization & administration

• Adult
• Critical care
• Diagnosis
• Expert consensus
• Thrombocytopenia
• Treatment

The primary aim of the present contribution is to find a literature-based agreement on dose adjustments of vitamin C in critically ill patients undergoing renal replacement therapy (RRT).

Critical illness is frequently accompanied by severe vitamin C deficiency. High-dose supplementation beneficially affects clinical outcome in small cohorts of patients with sepsis, burn injury, and trauma. There are no specific data on clinical outcomes in patients receiving renal replacement therapy (RRT). Vitamin C plasma concentrations in patients on RRT are comparable to critically ill patients not receiving RRT. Vitamin C is cleared from the circulation during RRT at a rate dependent on the plasma concentration, dose and duration of RRT. Sieving coefficient is about 1. While the dose of RRT is lower than normal renal function, tubular reabsorption is absent. Sparse evidence suggests that vitamin C dosing during continuous RRT should not exceed the dose administered to critically ill patients not receiving continuous RRT. Low plasma concentrations are expected during prolonged RRT because of persistent extracorporeal removal, absent renal reabsorption and enhanced metabolic loss due to circuit-induced oxidative stress. A dosage of twice 1 g vitamin C daily may be necessary to achieve normal plasma concentrations during RRT, but more studies are needed. There is no available evidence that high doses of vitamin C administered over a short period can induce oxalate stones or has pro-oxidant effects.

Supplementing vitamin C 1 g twice daily to critically ill patients has a solid pathophysiological rationale and a good safety profile. Patients on RRT probably need similar doses as critically ill patients not receiving RRT. Intravenous vitamin C in a dose of 2 g/day may be necessary to achieve normal plasma concentrations during RRT. However, data on dose adjustment of vitamin C during intermittent or chronic RRT are sparse and require more thorough pharmacokinetic and dose–response studies.

• Burns
• High-dose vitamin C
• Peritoneal dialysis
• Prevention of acute kidney injury
• Renal replacement therapy
• Sepsis
• Trauma
• Vitamin C

• medical research
• continuous renal replacement therapy

• Acute Kidney Injury/metabolism
• Acute Kidney Injury/mortality
• Acute Kidney Injury/physiopathology
• Adult
• Aged
• Continuous Renal Replacement Therapy/methods
• Critical Illness/mortality
• Female
• Humans
• Male
• Metals, Heavy/analysis
• Metals, Heavy/blood
• Micronutrients/analysis
• Micronutrients/blood
• Middle Aged
• Prospective Studies
• Renal Replacement Therapy/methods
• Vitamins/analysis
• Vitamins/blood

• European Society of Intensive Care Medicine

• CRRT
• Vitamin C
• elimination by convection
• elimination by diffusion

Ascorbic acid (vitamin C) elicits pleiotropic effects in the body. Among its functions, it serves as a potent anti-oxidant, a co-factor in collagen and catecholamine synthesis, and a modulator of immune cell biology. Furthermore, an increasing body of evidence suggests that high-dose vitamin C administration improves hemodynamics, end-organ function, and may improve survival in critically ill patients. This article reviews studies that evaluate vitamin C in pre-clinical models and clinical trials with respect to its therapeutic potential.

• Ascorbic acid
• vitamin C
• Sepsis
• Shock
• Critical care medicine
• Vasopressors
• Cardiovascular

• enteral nutrition
• extracorporeal membrane oxygenation
• newborn infant
• nutrition requirements
• parenteral nutrition
• renal replacement therapy