Hill Aileen, Starchl Christina, Dresen Ellen, Stoppe Christian, Amrein Karin
Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany.
Front Med (Lausanne). 2023 Jan 11;9:1083760. doi: 10.3389/fmed.2022.1083760. eCollection 2022.
Many critically ill patients are vitamin D and vitamin C deficient and the current international guidelines state that hypovitaminoses should be compensated. However, uncertainty about optimal dosage, timing and indication exists in clinical routine, mainly due to the conflicting evidence. This narrative review discusses both micronutrients with regards to pathophysiology, clinical evidence of benefits, potential risks, and guideline recommendations. Evidence generated from the most recent clinical trials are summarized and discussed. In addition, pragmatic tips for the application of these vitamins in the clinical routine are given. The supplementations of vitamin D and C represent cost-effective and simple interventions with excellent safety profiles. Regarding vitamin D, critically ill individuals require a loading dose to improve 25(OH)D levels within a few days, followed by a daily or weekly maintenance dose, usually higher doses than healthy individuals are needed. For vitamin C, dosages of 100-200 mg/d are recommended for patients receiving parenteral nutrition, but needs may be as high as 2-3 g/d in acutely ill patients.
许多重症患者存在维生素D和维生素C缺乏的情况，当前国际指南指出维生素缺乏应予以纠正。然而，在临床实践中，对于最佳剂量、给药时间和适应症仍存在不确定性，主要原因是证据相互矛盾。这篇叙述性综述讨论了这两种微量营养素在病理生理学、有益的临床证据、潜在风险和指南建议等方面的情况。总结并讨论了最新临床试验得出的证据。此外，还给出了在临床实践中应用这些维生素的实用建议。补充维生素D和C是具有成本效益且简单的干预措施，安全性良好。对于维生素D，重症患者需要负荷剂量以在数天内提高25(OH)D水平，随后每日或每周给予维持剂量，通常所需剂量高于健康个体。对于维生素C，接受肠外营养的患者建议剂量为100 - 200mg/d，但急性病患者的需求量可能高达2 - 3g/d。
