"Vitamin C, thiamine, and hydrocortisone combo"

Q: What is the logic behind adding thiamine into "Vitamin C, thiamine, and hydrocortisone combo" adjuvant treatment in sepsis?



Answer: Paul Marik recently demonstrated the benefit of using a combination of high dose vitamin C, thiamine, and stress dose hydrocortisone in patients with sepsis. High dose vitamin C may cause renal oxalate crystallization. Thiamine (vitamin B1) prevents this crystallization. 

The combination doses suggested are 

• IV vitamin C - 1.5 g q 6 hours for four days or until ICU discharge
• IV thiamine - 200 mg q 12 hours for four days or until ICU discharge 
• IV hydrocortisone - 50 mg q 6 hours for seven days or until ICU discharge

#sepsis

#pharmacology

Reference: 

Marik PE, Khangoora V, Rivera R, et al. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest 2017; 151:1229.