Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders

Abstract

Background At least a third of the world’s population consumes alcohol regularly. Patients with alcohol use disorders (AUDs) are frequently hospitalized for both alcohol-related and unrelated medical conditions. It is well recognized that patients with an AUD are thiamine deficient with thiamine replacement therapy being considered the standard of care. However, the incidence of vitamin C deficiency in this patient population has been poorly defined. Methods In this retrospective, observational study, we recorded the admission vitamin C level in patients with an AUD admitted to our medical intensive care unit (MICU) over a 1-year period. In addition, we recorded relevant clinical and laboratory data including the day 2 and day 3 vitamin C level following empiric treatment with vitamin C. Septic patients were excluded from this study. Results Sixty-nine patients met the inclusion criteria for this study. The patients’ mean age was 53 ± 14 years; 52 patients (75%) were males. Severe alcohol withdrawal syndrome was the commonest admitting diagnosis (46%). Eighteen patients (26%) had cirrhosis as the admitting diagnosis with 18 (13%) patients admitted due to alcohol/drug intoxication. Forty-six patients (67%) had evidence of acute alcoholic hepatitis. The mean admission vitamin C level was 17.0 ± 18.1 μmol/l (normal 40–60 μmol/l). Sixty-one (88%) patients had a level less than 40 μmol/l (subnormal) while 52 patients (75%) had hypovitaminosis C (level < 23 μmol/l). None of the variables recorded predicted the vitamin C level. Various vitamin C replacement dosing strategies were used. A 1.5-g loading dose, followed by 500-mg PO q 6, was effective in restoring blood levels to normal by day 2. Conclusion Our results suggest that hypovitaminosis C is exceedingly common in patients with an AUD admitted to an intensive care unit and that all such patients should receive supplementation with vitamin C in addition to thiamine. Additional studies are required to confirm the findings of our observational study and to determine the optimal vitamin C dosing strategy.

Evaluating extremely low plasma ascorbate levels and reduction of plasma ascorbate levels by dialysis in Japanese hemodialysis patients

“…The recommended dietary allowance (RDA) of vitamin C for a healthy adult is 100 mg per day in Japan and 90 mg and 75 mg per day for men and women, respectively, in the United States to prevent scurvy [23]. The average concentration of ascorbate in the plasma of healthy humans is 40-60 µM [24,25]. When the plasma ascorbate concentration drops to below 11 µM, there is a risk of developing scurvy, which is thus conventionally considered deficient [24,25].…”

“…The average concentration of ascorbate in the plasma of healthy humans is 40-60 µM [24,25]. When the plasma ascorbate concentration drops to below 11 µM, there is a risk of developing scurvy, which is thus conventionally considered deficient [24,25]. In our previous report regarding chronic obstructive pulmonary disease (COPD) and plasma ascorbate levels, we reported that plasma ascorbate levels were significantly lower in COPD patients (mean age 72.7 ± 6.9 years) than those in healthy elderly people (mean age 68.8 ± 3.8 years) using the same procedure and method as here [20].…”

“…Plasma ascorbate levels in non-hemodialysis CKD patients and hemodialysis patients were 27.1 ± 2.7 µM and 12.0 ± 1.4 µM, respectively. Since there is a risk of developing scurvy when the plasma ascorbate concentration drops to below 11 µM [24,25], many Japanese hemodialysis patients are likely develop scurvy (see Fig. 3).…”

Plant Kingdom as Source of Vitamins

“…At present, this disease is rare but continues to exist, in particular in people affected by malnutrition. It also occurs in adults and children with mental disorders, people with bad eating habits or alcoholism, and older people without medical supervision (Agarwal et al 2015;Fiorini et al 2018;Kothari et al 2020;Marik and Liggett 2019;Urueña-Palacio et al 2018). Scurvy symptoms can be linked to a total body pool of less than 300 mg and a plasma ascorbate concentration below 10 μM (EFSA NDA Panel 2013b; Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds 2000).…”

Delirium tremens: early diagnosis and intensive care guidelines. Review

“…При алкогольном делирии, несмотря на отсутствие признаков сопутствующих заболеваний и энцефалопатии Вернике, рекомендуют введение 500 мг тиамина в течение 30 мин 1-2 раза/сут на протяжении трех дней [62,63]. Рациональным является также введение мультивитаминых препаратов [63], так как у пациентов с алкогольной зависимостью отмечается дефицит ряда витаминов [64]. При наличии признаков энцефалопатии Вернике, риск которой достаточно велик при алкогольном делирии в анамнезе [62], вводят 500 мг тиамина 3 раза/сут в течение 5 дней в сочетании с поливитаминными препаратами.…”