Vitamin C in critical care, a Safety warning.

Sartor Z, Kesey J, Dissanaike S. The effects of intravenous vitamin C on point-of-care glucose monitoring. J Burn Care Res. 2015;36:50-56. It seems that we should not rely PoC glucose for patients treated with Vitamin C. Risk for insulin therapy stands out. https://www.ncbi.nlm.nih.gov/pubmed/24502221

Plasma and Vitamin C for shock resuscitation.

While it is easy to make the steady-state Starling case against colloids for resuscitation from hypovolaemia,  the argument from microvascular flow preservation keeps alive a possible indication for plasma infusions. The endothelial glycocalyx (EG) disintegrates after severe hemorrhagic shock, and there is laboratory evidence that plasma  could preserve or restore capillary integrity. Lyophilised plasma seems to be…… Continue reading Plasma and Vitamin C for shock resuscitation.

Lymph nodes reabsorb lymphatic fluid; a surgical application of an important principle.

I was surprised to learn of the work of Dr Corinne Becker at the Lymphoedema Centre, and with a little searching discovered that many surgeons are now offering autologous lymph node transplant for the treatment of lymphoedema. Students of the steady state Starling principle will understand the rationale; contrary to standard medical school physiology teaching,…… Continue reading Lymph nodes reabsorb lymphatic fluid; a surgical application of an important principle.

Law (English) and Ethics of withholding Vitamin C for treatment of sepsis.

Yesterday I did some teaching for NHS HRA Research Ethics Committees in London. I took the opportunity to present the Paul Marik story and covered the pros and cons of offering this treatment “on the NHS” as even-handedly as I could. Then I asked for a show of hands on who would demand a “proper” UK-based…… Continue reading Law (English) and Ethics of withholding Vitamin C for treatment of sepsis.