Posts Tagged ‘Sepsis’

Another case of contaminated IV fluids

Monday, April 4th, 2011

On February 28 I posted an article about IV fluid contamination from India. The United States is not immune from poor manufacturing practices as this news article from BBC illustrates.

30 March 2011

Alabama bacteria outbreak: US officials join probe

The culprit: Serratia bacteria tend to spread in hospital patients’ respiratory and urinary tracts

Federal officials are investigating an outbreak of a bacterial blood infection that killed nine patients and made 10 others ill in Alabama hospitals.

The victims, already seriously ill, were stricken with Serratia marcescens bacteraemia this month.

All had been given an intravenous nutritional product manufactured by an Alabama company, which recalled all of its products following the outbreak.

But an Alabama health official warned the outbreak’s origin remained unclear.

‘Contained’

The stricken patients at six Alabama hospitals were all taking an intravenous nutritional product manufactured by a single pharmacy, Meds IV, the state Department of Public Health said in a Tuesday statement.

Upon learning of the outbreak, the company ceased production and on 24 March recalled all of its intravenous products, the department said.

“We’re not expecting any additional cases,” Dr Mary McIntyre, of the department’s bureau of communicable disease, told the BBC. “It has been contained.”

But she cautioned that investigators had not directly linked the outbreak to the nutritional product, called TPN (total parenteral nutrition).

She said the federal Centers for Disease Control and Prevention, and the Food and Drug Administration had joined state authorities in the investigation.

I would suggest reviewing the points made in the last posting as well as IV seminar notes regarding safety!

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Vitamin C: A Potential Life-saving Treatment For Sepsis and Burns

Tuesday, February 8th, 2011

This short article about IV vitamin C originally appeared in Medical News Today, www.medicalnewstoday.com on November 19, 2010. Since the FDA is taking action against manufacturers of IV vitamin C (IVC) by declaring it a new unapproved drug, it is timely to see a university research institute supporting rational use of IVC to treat serious  illness that may not respond to drugs.

Physicians caring for patients with sepsis may soon have a new safe and cost-effective treatment for this life-threatening illness. Research led by Dr. Karel Tyml and his colleagues at The University of Western Ontario and Lawson Health Research Institute have found that vitamin C can not only prevent the onset of sepsis, but can reverse the disease.

Sepsis is caused by a bacterial infection that can begin anywhere in your body. Your immune system goes into overdrive, overwhelming normal processes in your blood. The result is that small blood clots form, blocking blood flow to vital organs. This can lead to organ failure. Babies, the elderly and those with weakened immune systems are most likely to get sepsis. But even healthy people can become deathly ill from the disease.

According to Dr. Tyml, a professor at Western’s Schulich School of Medicine & Dentistry, patients with severe sepsis have a high mortality rate, nearly 40 percent, because there is no effective treatment.

“There are many facets to sepsis, but the one we have focused on for the past 10 years is the plugging of capillaries,” says Dr. Tyml. Plugged capillaries prevent oxygenation and the supply of life-supporting materials to your organ tissue and stop the removal of metabolic waste product. Plugged capillaries are seen in organs of septic patients. These organs may eventually fail, leading to multiple organ failure and death. Dr. Tyml’s lab was the first to discover this plugging by using intravital microscopy, a technique Dr. Tyml pioneered in Canada.

According to Dr. Tyml’s most recent publication, oxidative stress and the activated blood clotting pathway are the major factors responsible for the capillary plugging in sepsis. Through his research, Dr. Tyml has discovered that a single bolus of vitamin C injected early at the time of induction of sepsis, prevents capillary plugging. He has also found that a delayed bolus injection of vitamin C can reverse plugging by restoring blood flow in previously plugged capillaries.

“Our research in mice with sepsis has found that early as well as delayed injections of vitamin C improves chance of survival significantly,” explains Dr. Tyml. “Furthermore, the beneficial effect of a single bolus injection of vitamin C is long lasting and prevents capillary plugging for up to 24 hours post-injection.”

Dr. Tyml and his colleagues are eager to find appropriate support to move this research from the bench to the bedside to see if these findings translate to patients with sepsis.

The potential benefit of this treatment is substantial. “Vitamin C is cheap and safe. Previous studies have shown that it can be injected intravenously into patients with no side effects,” says Dr. Tyml. “It has the potential to significantly improve the outcome of sepsis patients world-wide. This could be especially beneficially in developing countries where sepsis is more common and expensive treatments are not affordable.”

Source:
Kathy Wallis
University of Western Ontario

IVC is also showing promise as a treatment for burns. Here is a short excerpt from http://emedicine.medscape.com/article/1277360-overview.

Vitamin C1, 2

A great deal of interest exists in using antioxidants as adjuncts to resuscitation to try to minimize oxidant-mediated contributions to the inflammatory cascade. In particular, megadose vitamin C infusion during resuscitation has been studied at some length. Some animal models have demonstrated that infusion of vitamin C within 6 hours postburn can lower calculated resuscitation values by up to one half. Whether this phenomenon can be reproduced successfully in human subjects has not been clearly demonstrated.

Proponents have reached no consensus regarding the proper total dose. Some have adopted the strategy of placing up to 10 g in a liter of RL solution, infusing it at 100 mL/h (1 g/h vitamin C), and counting the volume as part of the resuscitation volume. Recently published data using an infusion of 66 mg/kg/h during the first 24 hours demonstrate a 45% decrease in the required fluid resuscitation in a small group of patients.

The safety of high-dose vitamin C has been established in humans, at least for the short-term, but this strategy is probably less safe in patients who are pregnant, those with renal failure, and those with a history of oxalate kidney stones.

  1. Sakurai M, Tanaka H, Matsuda T, et al. Reduced resuscitation fluid volume for second-degree experimental burns with delayed initiation of vitamin C therapy (beginning 6 h after injury). J Surg Res. Nov 1997;73(1):24-7. [Medline].
  2. Tanaka H, Matsuda T, Miyagantani Y, et al. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study. Arch Surg. Mar 2000;135(3):326-31. [Medline].

Please note that both references are from Japan; perhaps there is less peer pressure to avoid non-pharmaceutical treatments in Japan, even though these treatments are safe and effective. Here is a 1992 article from the same group.

Burns. 1992 Apr;18(2):127-31.
High-dose vitamin C therapy fro extensive deep dermal burns.
Matsuda T
, Tanaka H, Shimazaki S, Matsuda H, Abcarian H, Reyes H, Hanumadass M.

Abstract

We studied the haemodynamic effects of antioxidant therapy with high-dose vitamin C administration (170 mg/kg/24 h) in guinea-pigs with 70 per cent body surface area deep dermal burns. The animals were divided into three groups of six animals each. Group 1 was resuscitated with Ringer’s lactate solution according to the Parkland formula; group 2 with 25 per cent of the Parkland formula with vitamin C; and group 3 with 25 per cent of the Parkland formula without vitamin C. There were no significant differences in heart rates or in blood pressures between the groups throughout the 24-h study period. Group 3 showed significantly higher haematocrit values at 3 h postburn and thereafter as compared with those of group 2. The cardiac output values of group 2 were significantly higher than those of group 3, but equivalent to those of group 1. The water content of the burned skin in group 2 was significantly lower than that in the other groups, indicating that increased postburn capillary permeability was minimized by the administration of vitamin C. With adjuvant high-dose vitamin C administration, we were able to reduce the 24-h resuscitation fluid volume from 4 ml/kg/per cent burn to 1 ml/kg/per cent burn, while maintaining adequate cardiac output.

Here are two bullet points from an article from the Journal of Burn Care & Research July/August 2007. Burn Resuscitation by David G. Greenhalgh,

A multicenter trial to examine the role of vitamin C during burn shock resuscitation should be performed.

The last topic for investigation is to test an agent that will reduce the capillary leak that occurs during burn shock. The investigation of high dose vitamin C seems to make the most sense for the first trial.




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