Harm of IV High-Dose Vitamin C Therapy in Adult Patients: A Scoping Review. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Yanase, Fumitaka; Fujii, Tomoko; Naorungroj, Thummaporn; Belletti, Alessandro; Luethi, Nora; Carr, Anitra C.; Young, Paul J.; Bellomo, Rinaldo
• Is Part Of: Critical care medicine. Volume 48:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: adverse event -- ascorbic acid -- glucose-6-phosphate dehydrogenase deficiency -- harm -- oxaluria -- vitamin C; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000004396
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objectives: The potential harm associated with the use of IV vitamin C has not been systematically assessed. We aimed to review the available evidence on harm related to such treatment. Data Sources: We searched MEDLINE, EMBASE, Cochrane Library, National Institute of Health Clinical Trials Register, and World Health Organization International Clinical Trials Registry Platform. Study Selection: We included studies in adult population that reported harm related to IV high-dose vitamin C which we defined as greater than or equal to 6 g/d, greater than or equal to 75 mg/kg/d, or greater than or equal to 3 g/m 2 /d. Data Extraction: Two independent investigators screened records and extracted data. Data Synthesis: We identified 8, 149 reports, of which 650 full text were assessed for eligibility, leaving 74 eligible studies. In these studies, 2, 801 participants received high-dose vitamin C at a median (interquartile range) dose of 22.5 g/d (8.25–63.75 g/d), 455 mg/kg/d (260–925 mg/kg/d), or 70 g/m 2 /d (50–90 g/m 2 /d); and 932 or more adverse events were reported. Among nine double-blind randomized controlled trials (2, 310 patients), adverse events were reported in three studies with an event rate per patient for high-dose vitamin C identical to placebo group in one study (0.1 [1/10] vs 0.1 [1/10]), numerically lower in one study (0.80 [672/839] vs 0.82 [709/869]), and numerically higher in one study (0.33 [24/73] vs 0.23 [17/74]). Six double-blind randomized controlled trials reported no adverse event in either group. Five cases of oxalate nephropathy, five cases of hypernatremia, three cases of hemolysis in glucose-6-phosphate dehydrogenase deficiency patients, two cases of glucometer error, and one case of kidney stones were also reported overall. Conclusions: There is no consistent evidence that IV high-dose vitamin C therapy is more harmful than placebo in double-blind randomized controlled trials. However, reports of oxalate nephropathy, hypernatremia, glucometer error, and hemolysis in glucose-6-phosphate dehydrogenase deficiency patients warrant specific monitoring. Abstract : Supplemental Digital Content is available in the text.