ascorbic-acid and Hypernatremia

The combination of ascorbic acid, corticosteroids, and thiamine has been identified as a potential therapy for septic shock.. To determine whether the combination of ascorbic acid, corticosteroids, and thiamine attenuates organ injury in patients with septic shock.. Randomized, blinded, multicenter clinical trial of ascorbic acid, corticosteroids, and thiamine vs placebo for adult patients with septic shock. Two hundred five patients were enrolled between February 9, 2018, and October 27, 2019, at 14 centers in the United States. Follow-up continued until November 26, 2019.. Patients were randomly assigned to receive parenteral ascorbic acid (1500 mg), hydrocortisone (50 mg), and thiamine (100 mg) every 6 hours for 4 days (n = 103) or placebo in matching volumes at the same time points (n = 102).. The primary outcome was change in the Sequential Organ Failure Assessment (SOFA) score (range, 0-24; 0 = best) between enrollment and 72 hours. Key secondary outcomes included kidney failure and 30-day mortality. Patients who received at least 1 dose of study drug were included in analyses.. Among 205 randomized patients (mean age, 68 [SD, 15] years; 90 [44%] women), 200 (98%) received at least 1 dose of study drug, completed the trial, and were included in the analyses (101 with intervention and 99 with placebo group). Overall, there was no statistically significant interaction between time and treatment group with regard to SOFA score over the 72 hours after enrollment (mean SOFA score change from 9.1 to 4.4 [-4.7] points with intervention vs 9.2 to 5.1 [-4.1] points with placebo; adjusted mean difference, -0.8; 95% CI, -1.7 to 0.2; P = .12 for interaction). There was no statistically significant difference in the incidence of kidney failure (31.7% with intervention vs 27.3% with placebo; adjusted risk difference, 0.03; 95% CI, -0.1 to 0.2; P = .58) or in 30-day mortality (34.7% vs 29.3%, respectively; hazard ratio, 1.3; 95% CI, 0.8-2.2; P = .26). The most common serious adverse events were hyperglycemia (12 patients with intervention and 7 patients with placebo), hypernatremia (11 and 7 patients, respectively), and new hospital-acquired infection (13 and 12 patients, respectively).. In patients with septic shock, the combination of ascorbic acid, corticosteroids, and thiamine, compared with placebo, did not result in a statistically significant reduction in SOFA score during the first 72 hours after enrollment. These data do not support routine use of this combination therapy for patients with septic shock.. ClinicalTrials.gov Identifier: NCT03389555.

Topics: Adrenal Cortex Hormones; Adult; Aged; Ascorbic Acid; Cross Infection; Drug Therapy, Combination; Female; Humans; Hyperglycemia; Hypernatremia; Male; Middle Aged; Multiple Organ Failure; Organ Dysfunction Scores; Proportional Hazards Models; Shock, Septic; Thiamine; Treatment Failure

The use of polyethylene glycol (PEG)-based solutions is the gold standard for bowel preparation. However, PEG use might be associated with the risk of acute kidney injury.. We aimed to compare the safety of 2 L PEG plus ascorbic acid (AA) versus 4 L PEG.. Health examinees that underwent colonoscopy and blood tests on the same day at our center were included in this retrospective study. All subjects were prescribed either 2 L PEG plus AA or 4 L PEG for the bowel preparation prior to the colonoscopy. The incidences of electrolyte imbalance and renal impairment after colonic preparation were investigated. Renal impairment was determined if the subject's estimated glomerular filtration rate was measured less than 60 mL/min/1.73 m. Of the 29,789 cases, 14,790 received 2 L PEG plus AA (group A) and 14,999 received 4 L PEG (group B) for colonic preparation. Renal impairment occurred more commonly in group A (n = 467, 3.2 %) than in group B (n = 189, 1.3 %). Electrolyte changes such as hypernatremia and hyperkalemia were more common in group A than group B, whereas hyponatremia, hypokalemia, and hypophosphatemia were more common in group B than group A. Old age, male sex, and the use of 2 L PEG plus AA were independent risk factors for renal impairment.. The evidence strongly suggests that acute kidney injury is more likely to occur when 2 L PEG plus AA is used for the bowel preparation than when 4 L PEG is used.. KCT0001703.

Topics: Acute Kidney Injury; Adult; Age Factors; Ascorbic Acid; Cathartics; Colonoscopy; Creatinine; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Humans; Hyperkalemia; Hypernatremia; Hypophosphatemia; Incidence; Male; Middle Aged; Polyethylene Glycols; Retrospective Studies; Risk Factors; Sex Factors; Water-Electrolyte Imbalance

A survey of mothers attending infant welfare clinics showed that 26% changed their infant's milk in the first two weeks after birth and that multiple changes were common. Twenty-two per cent. were preparing a milk formula more concentrated than the recommended strength by using either heaped or packed scoops instead of level scoops of powder or by giving extra scoops. The commonest age for starting solid feeding was between 3 and 4 weeks and the practice of adding rusk or cereal to the bottle was common. There are obvious dangers of hypernatraemia from taking concentrated milk feeds and problems of obesity which may follow the early introduction of cereals.

Topics: Animals; Ascorbic Acid; Edible Grain; Humans; Hypernatremia; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Infant, Newborn; Milk; Mother-Child Relations; Obesity; Powders; Vitamin A; Vitamin D

Topics: Ascorbic Acid; Birth Weight; Breast Feeding; Gastroenteritis; Humans; Hypernatremia; Infant Food; Infant Nutrition Disorders; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Newborn, Diseases; Metabolism, Inborn Errors; Respiratory Tract Infections; Tetany; Vitamin A; Vitamin D; Vitamin K; Vomiting