World J Crit Care Med. Oct 16, 2018; 7(5): 52-61
Published online Oct 16, 2018. doi: 10.5492/wjccm.v7.i5.52

Vitamin C in the critically ill – indications and controversies

Christoph S Nabzdyk, Edward A Bittner
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.
Correspondence to: Edward A Bittner, MD, PhD, MSEd, Associate Professor, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States.
Telephone: +1-617-7263030 Fax: +1-617-7267536
Published online:October 16, 2018

Ascorbic acid (vitamin C) elicits pleiotropic effects in the body. Among its functions, it serves as a potent anti-oxidant, a co-factor in collagen and catecholamine synthesis, and a modulator of immune cell biology.Furthermore, an increasing body of evidence suggests that high-dose vitamin C administration improves hemodynamics, end-organ function, and may improve survival in critically ill patients. This article reviews studies that evaluate vitamin C in pre-clinical models and clinical trials with respect to its therapeutic potential.



Vitamin C is one of the most well-known essential nutrients and is believed by many to confer a litany of health benefits (Figure 1). The Nobel Prize Winner Linus Pauling may have been the foremost ambassador to date who suggested that vitamin C would enhance cardiovascular health, improve the body’s immune function to overcome infections, and even help abate cancer[14]. These health claims created significant controversies that lasted for decades. While many of Pauling’s “more is better” claims have not been supported by rigorous scientific investigation, a growing number of benefits of vitamin C administration have been identified for medical treatment, including in the field of critical care. This mini-review will examine the evidence in support of vitamin C administration for critically ill patients and provide general recommendations for use by intensive care unit practitioners.

Figure 1
Figure 1 Biological functions of vitamin C.NK: Natural killer cells; ICAM: Intercellular adhesion molecule.
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