Abstract
BackgroundAt 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.MethodsIn 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.ResultsSixty-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.ConclusionOur 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.
Highlights
At least a third of the world’s population consumes alcohol regularly
We report the incidence and risk factors for hypovitaminosis C in a cohort of alcohol use disorders (AUDs) patients admitted to our medical ICU
The most frequent diagnosis associated with AUD was severe alcohol withdrawal syndrome (46%), followed by complications associated with alcoholic cirrhosis—encephalopathy or gastrointestinal bleeding (26%) and acute alcohol intoxication associated with substance abuse (13%)
Summary
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. Few studies have evaluated vitamin C levels in patients with AUDs. It is well recognized that thiamine deficiency is common in patients with AUD [6]. Low serum levels of vitamin C are common in critically ill patients [7, 8]; this likely compounds the vitamin C nutritional deficiency of alcoholic patients admitted to the ICU. As part of our sepsis protocol in which we routinely administer adjuvant vitamin C [19], we noted that AUD patients were frequently vitamin C deficient Based on this observation, we routinely measure vitamin C levels in our AUD patients and administer vitamin C together with thiamine, magnesium, and folate in the dosages as suggested by Flannery et al [6].
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