CHEST Guidelines-Response_chest

Response_chest_8 (2)

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The document consists of a letter and a response discussing the role of thiamine in a treatment regimen known as the "Vitamin C Cocktail" for severe sepsis and septic shock. The original study by Marik et al. observed a significant reduction in mortality when using a combination of intravenous vitamin C, hydrocortisone, and thiamine. While much discussion has concentrated on the role of vitamin C and corticosteroids, the authors of the letter stress the importance of thiamine, suggesting it may be underappreciated.<br /><br />Thiamine, a co-factor in crucial metabolic reactions, is highlighted for its potential benefits beyond preventing oxalate-induced renal issues, particularly in critically ill patients who are often thiamine deficient. Thiamine's involvement in reducing oxidative stress, inflammation, and glutamate excitotoxicity is noted, and prior studies indicate that thiamine supplementation in thiamine-deficient septic patients resulted in lower lactate levels and a reduced need for renal replacement therapy.<br /><br />The response from Marik and colleagues acknowledges the points raised, confirming that thiamine was included in their study mainly to reduce the risk of hyperoxalosis. They highlight thiamine's protective qualities, particularly against renal injury, oxidative stress, and its role in immune and endothelial functions.<br /><br />Both pieces suggest further research should focus on different combinations of the cocktail concerning baseline vitamin deficiencies in patients to understand the full potential of these treatments in improving outcomes in sepsis and septic shock.

Keywords

thiamine

Vitamin C Cocktail

sepsis

septic shock

Marik study

intravenous vitamin C

hydrocortisone

oxidative stress

renal injury

immune function