Unintended Consequence of High-Dose Vitamin C Therapy for an Oncology Patient: Evaluation of Ascorbic Acid Interference With Three Hospital-Use Glucose Meters

Katzman, Brooke M.; Kelley, Brandon R.; Deobald, Gayle R; Myhre, Nikki K; Agger, Sean A.; Karon, Brad S.

doi:10.1177/1932296820932186

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…Intriguingly, the current study revealed a phenomenon of blood glucose measurement interference, in consistent with previous studies [ 30 – 32 ]. Our glucose-monitoring device adopted glucose oxidase method.…”

Section: Discussionsupporting

confidence: 93%

Early administration of hydrocortisone, vitamin C, and thiamine in adult patients with septic shock: a randomized controlled clinical trial

Lyu

Zheng

Chen³

et al. 2022

Crit Care

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Background The combination therapy of hydrocortisone, vitamin C, and thiamine has been proposed as a potential treatment in patients with sepsis and septic shock. However, subsequent trials have reported conflicting results in relation to survival outcomes. Hence, we performed this randomized controlled trial (RCT) to evaluate the efficacy and safety of early combination therapy among adult patients with septic shock. Methods This single-center, double-blind RCT enrolled adult patients with diagnosis of septic shock within 12 h from Northern Jiangsu People's Hospital between February 2019 and June 2021. Recruited patients were randomized 1:1 to receive intervention (hydrocortisone 200 mg daily, vitamin C 2 g every 6 h, and thiamine 200 mg every 12 h) or placebo (0.9% saline) for 5 days or until ICU discharge. The primary endpoint was 90-day mortality. The secondary endpoints included mortality at day 28, ICU discharge, and hospital discharge; shock reversal; 72-h Delta SOFA score; ICU-free days, vasopressor-free days, and ventilator support -free days up to day 28; ICU length of stay (LOS) and hospital LOS. Results Among 426 patients randomized, a total of 408 patients with septic shock were included in the per-protocol (PP) analysis, of which 203 were assigned to the intervention group and 205 to the placebo group. In the PP population, the primary outcome of 90-day mortality was 39.9% (81/203) and 39.0% (80/205) in the intervention and the placebo groups, respectively, and was not significantly different (P = 0.86). There was no significant difference between two groups in 28-day mortality (36.5% vs. 36.1%, P = 0.94) or the ICU mortality (31.5% vs. 28.8%, P = 0.55) and hospital mortality (34.5% vs. 33.2%, P = 0.78). No other secondary outcomes showed significant differences between two groups, including shock reversal, vasopressor-free days, and ICU LOS. Intention-to-treat analysis included all the 426 patients and confirmed these results (all P > 0.05). Conclusion Among adult patients with septic shock, early use of hydrocortisone, vitamin C, and thiamine combination therapy compared with placebo did not confer survival benefits. Trial registration ClinicalTrials.gov: NCT03872011, registration date: March 12, 2019. Graphic Abstract

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Section: Discussionsupporting

confidence: 93%

Early administration of hydrocortisone, vitamin C, and thiamine in adult patients with septic shock: a randomized controlled clinical trial

Lyu

Zheng

Chen³

et al. 2022

Crit Care

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“…Of these, only the Nova StatStrip glucose meter specifically gave an "error" result for glucose readings that prompted clinicians to confirm POC-BG values with a venous blood sample. 9 There are various sources of error in measuring POC-BG and these can pose a safety hazard to patient care. Chemical interference with the BG meter strip is only one of these.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, only the Nova StatStrip glucose meter specifically gave an “error” result for glucose readings that prompted clinicians to confirm POC-BG values with a venous blood sample. 9 …”

Section: Discussionmentioning

confidence: 99%

Pseudohyperglycemia Secondary to High-Dose Intravenous Vitamin C Managed as Diabetic Ketoacidosis: An Endocrinological Catastrophe

Orija

Zahid

2021

AACE Clinical Case Reports

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Objective: To create awareness among health care professionals and nurses regarding interference with point-of-care (POC) blood glucose (BG) meter by high-dose intravenous vitamin C and other potential substances. We report a case that probably resulted in the death of a patient from an erroneous interpretation of POC-BG readings due to interference from high-dose vitamin C. Methods: Retrospective case review Results: Our patient was admitted following a syncopal episode associated with an acute non-ST elevation myocardial infarction. She was found to have significant hyperglycemia with blood glucose >600 mg/dL on POC testing, associated with moderate ketoacidosis. She was treated with intravenous insulin as a case of diabetic ketoacidosis (DKA). She developed severe hypoglycemia, which was confirmed on a venous BG, and her condition was complicated by an apparent stroke-like state. The patient deteriorated and subsequently died. We found no report of vitamin C causing apparent DKA, as seen in our case. Conclusion: POC-BG monitoring is very commonly used in intensive care unit settings to monitor BG as they are minimally invasive, convenient, and quick. However, physicians and nurses need to be aware that certain substances can interfere with and alter POC-BG levels, leading to incorrect diagnosis of pseudohyperglycemia or pseudohypoglycemia. This may potentially lead to catastrophic consequences and result in increased morbidity and mortality in intensive care unit settings. The Food and Drug Administration advises against the use of POC-BG meters in critical settings, and they should never be used to diagnose DKA.

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“…[14][15][16] In studies that have been performed with systems for SMBG evaluating the impact of high doses of ascorbic acid application in oncology patients or patients with sepsis, some fail with high ascorbic acid levels in blood while others do not. [17][18][19] However, this may not be relevant for CGM systems as it is not known how high the corresponding levels of ascorbic acid are in the ISF. It is possible that ascorbic acid circulates into the ISF in the same way that glucose does because this vitamin has a similar structure to glucose.…”

Section: Abbott-ascorbic Acidmentioning

confidence: 99%

Interferences With CGM Systems: Practical Relevance?

Heinemann¹

2021

J Diabetes Sci Technol

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Unintended Consequence of High-Dose Vitamin C Therapy for an Oncology Patient: Evaluation of Ascorbic Acid Interference With Three Hospital-Use Glucose Meters

Cited by 9 publications

References 13 publications

Early administration of hydrocortisone, vitamin C, and thiamine in adult patients with septic shock: a randomized controlled clinical trial

Early administration of hydrocortisone, vitamin C, and thiamine in adult patients with septic shock: a randomized controlled clinical trial

Pseudohyperglycemia Secondary to High-Dose Intravenous Vitamin C Managed as Diabetic Ketoacidosis: An Endocrinological Catastrophe

Interferences With CGM Systems: Practical Relevance?

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