Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 423, Norfolk, VA, 23507, USA.
Department of Medicine, Eastern Virginia Medical School, 721 Fairfax ave, Norfolk, VA, 23507, USA.
Crit Care. 2019 May 10;23(1):165. doi: 10.1186/s13054-019-2435-4.
At least a third of the world's population consumes alcohol regularly. Patients with alcohol use disorders (AUDs) are frequently hospitalized for both alcohol-related and unrelated medical conditions. It is well recognized that patients with an AUD are thiamine deficient with thiamine replacement therapy being considered the standard of care. However, the incidence of vitamin C deficiency in this patient population has been poorly defined.
In this retrospective, observational study, we recorded the admission vitamin C level in patients with an AUD admitted to our medical intensive care unit (MICU) over a 1-year period. In addition, we recorded relevant clinical and laboratory data including the day 2 and day 3 vitamin C level following empiric treatment with vitamin C. Septic patients were excluded from this study.
Sixty-nine patients met the inclusion criteria for this study. The patients' mean age was 53 ± 14 years; 52 patients (75%) were males. Severe alcohol withdrawal syndrome was the commonest admitting diagnosis (46%). Eighteen patients (26%) had cirrhosis as the admitting diagnosis with 18 (13%) patients admitted due to alcohol/drug intoxication. Forty-six patients (67%) had evidence of acute alcoholic hepatitis. The mean admission vitamin C level was 17.0 ± 18.1 μmol/l (normal 40-60 μmol/l). Sixty-one (88%) patients had a level less than 40 μmol/l (subnormal) while 52 patients (75%) had hypovitaminosis C (level < 23 μmol/l). None of the variables recorded predicted the vitamin C level. Various vitamin C replacement dosing strategies were used. A 1.5-g loading dose, followed by 500-mg PO q 6, was effective in restoring blood levels to normal by day 2.
Our results suggest that hypovitaminosis C is exceedingly common in patients with an AUD admitted to an intensive care unit and that all such patients should receive supplementation with vitamin C in addition to thiamine. Additional studies are required to confirm the findings of our observational study and to determine the optimal vitamin C dosing strategy.
全球至少有三分之一的人口经常饮酒。患有酒精使用障碍（AUD）的患者经常因酒精相关和非酒精相关的医疗条件住院。众所周知，患有 AUD 的患者会出现硫胺素缺乏，而硫胺素替代疗法被认为是标准治疗方法。然而，该患者群体中维生素 C 缺乏的发生率尚未得到明确界定。
在这项回顾性观察研究中，我们记录了在过去一年中入住我们的重症监护病房（MICU）的 AUD 患者的入院时维生素 C 水平。此外，我们记录了相关的临床和实验室数据，包括经验性维生素 C 治疗后第 2 天和第 3 天的维生素 C 水平。本研究排除了脓毒症患者。
69 名患者符合本研究的纳入标准。患者的平均年龄为 53±14 岁；52 名男性（75%）。最常见的入院诊断是严重酒精戒断综合征（46%）。18 名患者（26%）的入院诊断为肝硬化，18 名患者（13%）因酒精/药物中毒入院。46 名患者（67%）有急性酒精性肝炎的证据。入院时的平均维生素 C 水平为 17.0±18.1μmol/L（正常值为 40-60μmol/L）。61 名（88%）患者的水平低于 40μmol/L（低于正常值），52 名（75%）患者有维生素 C 缺乏症（水平<23μmol/L）。记录的变量均不能预测维生素 C 水平。采用了各种维生素 C 替代剂量策略。1.5g 负荷剂量，随后 PO 500mg q6，可有效在第 2 天使血药浓度恢复正常。
我们的结果表明，入住重症监护病房的 AUD 患者中维生素 C 缺乏症极为常见，所有此类患者除了硫胺素之外，还应补充维生素 C。需要进一步的研究来证实我们的观察性研究结果，并确定最佳的维生素 C 剂量策略。
