Adjuvant vitamin C treatment in sepsis—how many oranges a day keep (vasopressor-dependent) septic shock away?

Vitamin C is an essential water-soluble vitamin that is involved in many biosynthetic and metabolic processes. In healthy fasting humans, circulating levels of ascorbate, the redox form of vitamin C, are typically in the range of 50–70 μmol/L (1). Levels <25 μmol/L reflect marginal deficiency (hypovitaminosis C). Severe (scurvy-like) vitamin C deficiency is present when levels fall below 10 μmol/L (2). In the critical care setting, vitamin C is particularly notorious for its strong immunomodulating and antioxidant activity. As such, vitamin C is promoted as adjuvant therapy in conditions characterized by excessive oxidative stress or crippled immunity such as ischemia-reperfusion disorders, trauma, and various inflammatory disease processes (3).