Publication: Harm of IV High-Dose Vitamin C Therapy in Adult Patients: A Scoping Review
Issued Date
2020-01-01
Resource Type
ISSN
15300293
00903493
00903493
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2-s2.0-85087649267
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Mahidol University
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SCOPUS
Bibliographic Citation
Critical Care Medicine. (2020), E620-E628
Suggested Citation
Fumitaka Yanase, Tomoko Fujii, Thummaporn Naorungroj, Alessandro Belletti, Nora Luethi, Anitra C. Carr, Paul J. Young, Rinaldo Bellomo Harm of IV High-Dose Vitamin C Therapy in Adult Patients: A Scoping Review. Critical Care Medicine. (2020), E620-E628. doi:10.1097/CCM.0000000000004396 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/58334
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Title
Harm of IV High-Dose Vitamin C Therapy in Adult Patients: A Scoping Review
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Abstract
© 2020 BMJ Publishing Group. All rights reserved. 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/m2/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/m2/d (50-90 g/m2/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.