High Dose of Vitamin C in Septic and Critically Ill Patients with COVID-19: A Narrative Review

Kiumarth Amini; Adeleh Sahebnasagh; Ronak Amini; Solomon Habtemariam; Farhad Najmeddin; Mojtaba Mojtahedzadeh

doi:10.18502/jnfs.v9i1.14845

Kiumarth Amini Student Research Committee, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Adeleh Sahebnasagh Clinical Research Center, Department of Internal Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
Ronak Amini Faculty of Pharmacy, Azad University, Tehran, Iran;
Solomon Habtemariam Pharmacognosy Research Laboratories and Herbal Analysis Services UK, University of Greenwich, Central Avenue, Chatham-Maritime, Kent ME4 4TB, United Kingdom
Farhad Najmeddin Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Mojtaba Mojtahedzadeh Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jnfs.v9i1.14845

Keywords: COVID-19; Vitamin C; Cytokine storm; Critically ill; Sepsis.

Abstract

Background: The coronavirus disease of 2019 (COVID-19) may be considered sepsis on the basis that all the pathological events and the subsequent organ-to-organ interaction in sepsis also occur in COVID-19. In this article, the authors first discussed the rationale for the use of vitamin C (Vit-C) in sepsis and septic patients. They also reviewed the role of a high dose of Vit-C in COVID-19, which included clinical trials designed for the management of this viral disease. Methods: The researchers explored databases of PubMed, Scopus, ISI Web of Science, and Google Scholar. Data were extracted to assess the effects of Vit-C in septic patients and also the efficacy of supplementation with a high dose of Vit-C regarding the clinical outcomes of patients with COVID-19. Results: Recent research findings indicate that severe inflammatory responses (cytokine storms) and oxidative stress are important causes for the high mortality in COVID-19 patients. It seems, however, that administering high doses of Vit-C can offer a therapeutic benefit. High doses of intravenous Vit-C, with its antioxidant properties and pleiotropic functions, could attenuate the tissue damage caused by excessive levels of free radicals following the cytokine storm and septic shock in severe cases of the disease. Conclusions: Recent literature suggests that high doses of Vit-C have a potential role in reducing mortality and intubation rates in critically ill COVID-19 patients. However, determining the optimal duration and dose of Vit-C in these patients requires further studies.