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Should ascorbic acid be a primary therapy for sepsis in prehospital settings?

02 January 2021
Volume 13 · Issue 1



Prehospital emergency medical services (EMS) are believed to be responsible for the initial treatment of 68 000 septic patients annually in the UK, 88% of whom have severely low ascorbic acid levels, which can lead to organ dysfunction, increasing the likelihood of mortality.


This review aims to determine if early therapeutic use of ascorbic acid (vitamin C) could reduce the deterioration of septic patients and therefore overall mortality.


A literature review was conducted using the mySearch, PubMed and Cochrane Library databases. Each was systematically searched for human studies that addressed the use of ascorbic acid as a primary method of treatment during varying stages of sepsis and whether it reduced associated mortality. Studies not published in English or that were more the 5 years old at the time were excluded. The quality of evidence in the remaining articles were appraised using the GRADE method and further assessed for quality with an adjusted Downs and Black scoring tool.


Nineteen articles were found, three of which met the inclusion criteria. All addressed the use of ascorbic acid as a therapy in the treatment of sepsis; none were conducted in a prehospital setting.


Intravenous ascorbic acid appears to be a safe and effective therapy in treating septic patients, with the potential to reduce mortality rates if given prophylactically. However, a series of clinical trials would need to be conducted to measure the extent of any improvement and therefore clinical value in the prehospital environment.

Of the 102 000 patients with sepsis who arrive annually at emergency departments in the UK, 68 000 (Smyth et al, 2016) have reportedly been conveyed by emergency medical services (EMS); 80% of them required intensive care treatment (Smyth et al, 2016), all of whom were found to have lowered vitamin C (ascorbic acid) levels (Carr et al, 2015). Recent studies in the intensive care unit (ICU) setting have identified this nutritional deficit as a key factor in the development of organ failure (Wilson, 2016).

Early clinical trials have shown that administering ascorbic acid has reduced mortality from sepsis-related organ dysfunction (Marik, 2017). However, prompt implementation seems to be a key feature for success (Boisramé-Helms et al, 2013) so it can be argued that prehospital clinicians such as paramedics are ideally placed to identify and initiate this form of treatment (Studnek et al, 2012). This is especially pertinent as those arriving by EMS are predominantly in a more advanced and critical stage of the condition (Seymour et al, 2010).

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