Vitamin C and Point of Care Glucose Measurements: A Retrospective, Observational Study

Stephenson, Elise; Hooper, Michael H.; Marik, Paul E.

doi:10.1016/j.chest.2018.08.232

Cited by 6 publications

(7 citation statements)

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“…Spurious point-of-care glucometer readings can occur following IVC administration due to interference of high concentrations of vitamin C with specific glucometer biochemistry [53]. At the doses used in the ICU setting, this generally only occurs in patients with renal impairment [54].…”

Section: Safety Of Oral and Intravenous Vitamin Cmentioning

confidence: 99%

Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence

Holford¹,

Carr

Zawari

et al. 2021

Life

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Severe respiratory infections are characterized by elevated inflammation and generation of reactive oxygen species (ROS) which may lead to a decrease in antioxidants such as vitamin C and a higher requirement for the vitamin. Administration of intravenous vitamin C to patients with pneumonia and sepsis appears to decrease the severity of the disease and potentially improve survival rate. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes pneumonia, sepsis and acute respiratory distress syndrome (ARDS) in severe cases, and is referred to as coronavirus disease 2019 (COVID-19). Patients with COVID-19 infection also appear to have depleted vitamin C status and require additional supplementation of vitamin C during the acute phase of the disease. To date there have been 12 vitamin C and COVID-19 trials published, including five randomised controlled trials (RCTs) and seven retrospective cohort studies. The current level of evidence from the RCTs suggests that intravenous vitamin C intervention may improve oxygenation parameters, reduce inflammatory markers, decrease days in hospital and reduce mortality, particularly in the more severely ill patients. High doses of oral vitamin C supplementation may also improve the rate of recovery in less severe cases. No adverse events have been reported in published vitamin C clinical trials in COVID-19 patients. Upcoming findings from larger RCTs will provide additional evidence on vitamin supplementation in COVID-19 patients.

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Section: Safety Of Oral and Intravenous Vitamin Cmentioning

confidence: 99%

Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence

Holford¹,

Carr

Zawari

et al. 2021

Life

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“…Preliminary evidence indicates that critically ill patients with renal impairment (oliguria) may exhibit spuriously high point-of-care glucose values following low dose intravenous vitamin C infusion. [3][4][5] Intravenous vitamin C can interfere with many point-ofcare glucose meters, even at low gram doses. 6 Point-ofcare glucose meters utilise a variety of different detection methods, including electrochemical detection using glucose dehydrogenase or glucose oxidase.…”

Section: Effect Of Intravenous Vitamin C On Arterial Blood Gas Analys...mentioning

confidence: 99%

Effect of intravenous vitamin C on arterial blood gas analyser and Accu-Chek point-of-care glucose monitoring in critically ill patients

Carr¹,

Rosengrave²,

Wohlrab³

et al. 2022

Critical Care and Resuscitation

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BACKGROUND: Intravenous vitamin C is known to interfere with some point-of-care blood glucose meters. We aimed to determine the concentrations at which ascorbate interferes with glucose concentrations measured using a point-of-care blood glucose meter. We also compared the point-of-care meter and an arterial blood gas (ABG) analyser in the intensive care unit with laboratory glucose monitoring in septic patients receiving intravenous vitamin C infusions. METHODS: Blood samples containing normal, depleted and supplemented glucose and increasing concentrations of ascorbate (0.1–1.0 mmol/L) were tested using an Accu-Chek Inform II (Roche Diagnostics, USA) glucometer. For the in vivo study, 41 individual blood samples were drawn daily from septic patients n = 16) receiving infusions of 25 mg/kg of vitamin C every 6 hours. The glucose values of matched blood samples were assessed using Accu-Chek, ABG and laboratory glucose methods. RESULTS: For every 1 mmol/L of ascorbate added, the glucose concentration measured by the point-of-care monitor increased by 1.4 mmol/L (95% CI, 1.0–1.8; P < 0.001). Analysis of matched blood samples collected following intravenous vitamin C infusion indicated that 98% of the ABG and 83% of the Accu-Chek values met the International Organization for Standardization (ISO) 15197:2013 accuracy criteria. One patient had severe renal impairment, which contributed to elevated plasma vitamin C concentrations (median, 0.95 mmol/L; range, 0.64–1.10 mmol/L), resulting in elevated Accu-Chek readings and presenting a moderate clinical risk for the highest value. CONCLUSIONS: Vitamin C concentrations < 0.8 mmol/L do not interfere with point-of-care glucose monitoring. Intravenous vitamin C infusion of 25 mg/kg every 6 hours does not interfere with point-of-care glucose monitoring unless the patient has renal impairment, in which case laboratory glucose tests should be used.

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“…The cumulative experience of the "Front Line Covid-19 Critical Care Alliance" (see https://flccc.net//) strongly supports the concept that ascorbic acid acts synergistically with glucocorticoids to reverse the cytokine storm and improve pulmonary function thereby dramatically reducing ventilator dependency and mortality from COVID-19. It should be noted that in patients receiving intravenous vitamin C, the Accu-Chek™ point-of-care (POC) blood glucose monitor will result in spuriously high blood glucose values [37,38]. Therefore, laboratory confirmation of blood glucose levels is recommended.…”

Section: Ascorbic Acidmentioning

confidence: 99%

MATH+ protocol for the treatment of SARS-CoV-2 infection: the scientific rationale

Marik

Kory

Varon

et al. 2020

Expert Review of Anti-infective Therapy

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Introduction: COVID-19 disease progresses through a number of distinct phases. The management of each phase is unique and specific. The pulmonary phase of COVID-19 is characterized by an organizing pneumonia with profound immune dysregulation, activation of clotting, and a severe microvascular injury culminating in severe hypoxemia. The core treatment strategy to manage the pulmonary phase includes the combination of methylprednisolone, ascorbic acid, thiamine, and heparin (MATH+ protocol). The rationale for the MATH+ protocol is reviewed in this paper. Areas covered: We provide an overview on the pathophysiological changes occurring in patients with COVID-19 respiratory failure and a treatment strategy to reverse these changes thereby preventing progressive lung injury and death. Expert opinion: While there is no single 'Silver Bullet' to cure COVID-19, we believe that the severely disturbed pathological processes leading to respiratory failure in patients with COVID-19 organizing pneumonia will respond to the combination of Methylprednisone, Ascorbic acid, Thiamine, and full anticoagulation with Heparin (MATH+ protocol).We believe that it is no longer ethically acceptable to limit management to 'supportive care' alone, in the face of effective, safe, and inexpensive medications that can effectively treat this disease and thereby reduce the risk of complications and death.

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Vitamin C and Point of Care Glucose Measurements: A Retrospective, Observational Study

Cited by 6 publications

References 0 publications

Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence

Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence

Effect of intravenous vitamin C on arterial blood gas analyser and Accu-Chek point-of-care glucose monitoring in critically ill patients

MATH+ protocol for the treatment of SARS-CoV-2 infection: the scientific rationale

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