Potential Harm of Vitamin C in Treating Patients with Septic Shock

In 2017, a single-center experience suggested dramatically lower mortality in patients with sepsis who were treated with vitamin C, thiamine, and steroids (NEJM JW Gen Med Aug 15 2017 and Chest 2017; 151:1229). Subsequent randomized trials have not confirmed the benefits of this cocktail (NEJM JW Gen Med Apr 15 2021 and JAMA 2021; 325:742). Steroids shorten the duration of refractory shock (without a clear effect on mortality), but questions remain about the value of vitamin C and thiamine.

International investigators randomized 863 patients with septic shock (i.e., on vasopressors at enrollment) to receive either intravenous vitamin C (50 mg every 6 hours for 4 days) or placebo within 24 hours of admission to the intensive care unit. Nearly…