title: Intravenous Vitamin C Administered as Adjunctive Therapy for Recurrent Acute Respiratory Distress Syndrome.
abstract: This case report summarizes the first use of intravenous vitamin C employed as an adjunctive interventional agent in the therapy ofrecurrentacute respiratory distress syndrome (ARDS). The two episodes of ARDS occurred in a young female patient with Cronkhite-Canada syndrome, a rare, sporadically occurring, noninherited disorder that is characterized by extensive gastrointestinal polyposis and malabsorption. Prior to the episodes of sepsis, the patient was receiving nutrition via chronic hyperalimentation administered through a long-standing central venous catheter. The patient became recurrently septic with Gram positive cocci which led to two instances of ARDS. This report describes the broad-based general critical care of a septic patient with acute respiratory failure that includes fluid resuscitation, broad-spectrum antibiotics, and vasopressor support. Intravenous vitamin C infused at 50 mg per kilogram body weight every 6 hours for 96 hours was incorporated as an adjunctive agent in the care of this patient. Vitamin C when used as a parenteral agent in high doses acts "pleiotropically" to attenuate proinflammatory mediator expression, to improve alveolar fluid clearance, and to act as an antioxidant.
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Bharara
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Grossman
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Daniel
authors.identifier: 0000-0002-7620-6166
authors.initials: D
authors.lastname: Grinnan
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Aamer
authors.initials: A
authors.lastname: Syed
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Bernard
authors.identifier: 0000-0002-3273-2025
authors.initials: B
authors.lastname: Fisher
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: DeWilde
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Ramesh
authors.identifier: 0000-0002-3431-9971
authors.initials: R
authors.lastname: Natarajan
authors.affiliation: Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, The VCU Johnson Center for Critical Care and Pulmonary Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Alpha A Berry
authors.identifier: 0000-0002-1445-8800
authors.initials: AA
authors.lastname: Fowler