Doctor—your septic patients have scurvy!

Excerpt

Scurvy is a disease of antiquity described in Egyptian Hieroglyphics and responsible for the deaths of thousands of sailors during the Renaissance. Today, clinicians consider scurvy a very rare disease seen only in patients with extreme dietary deficiencies. They would undoubtedly be shocked to learn that about 40% of the patients in their ICU with septic shock have serum levels of vitamin C supporting a diagnosis of scurvy (<11.3 u/mol/l). The remainder of their patients with sepsis are likely to have hypovitaminosis C (serum level < 23 u/mol/l). Half of their nonseptic ICU patients also have hypovitaminosis C. These are the findings recently reported by Carr et al. [1]. Surprisingly, these astonishing observations are not new. It has been known for over two decades that acute illness results in an acute deficiency of vitamin C with low serum and intracellular levels [2‐4]. Low plasma concentrations of vitamin C are associated with more severe organ failure and increased risk of mortality [5]. The most likely explanation for the acute vitamin C deficiency (acute scurvy) in patients with sepsis (and other critical illnesses) is a consequence of metabolic consumption [1]. The fall in serum and cellular levels occurs too rapidly to be explained by decreased gastrointestinal absorption or increased urinary losses. Indeed, in a guinea pig model, myocardial ascorbate was depleted within hours of endotoxin administration [6]. …