Vitamin C Infusion for Gastric Acid Aspiration-Induced Acute Respiratory Distress Syndrome (ARDS)

Abstract

Introduction: Gastric acid aspiration into the lung has long been established as a direct cause of acute lung injury that rapidly leads to a clinical diagnosis of acute respiratory distress syndrome (ARDS). Gastric juices contain a low pH liquid and frequently mouth organisms. When aspiration of gastric liquid into the lower airway occurs, a caustic injury to the lower airway and distal airspaces occurs. The acute inflammatory events that occur following gastric acid aspiration induce injury by direct lung tissue toxicity.1 As well, acute adhesion of activated blood neutrophils throughout the pulmonary microcirculation and the subsequent migration of activated cells into the alveolar space rapidly induces acute injury to the alveolar capillary membrane with subsequent rapid loss of lung barrier function. Virtually always acute lung injury of the magnitude described in the case we report here occurs, producing ARDS. Thus far, no therapy has reliably proven effective for gastric acid-induced ARDS.
Case Presentation: In this report, we describe the onset of acute respiratory failure with rapid onset ARDS in a 34-year-old patient who experienced a generalized tonicclonic seizure followed by witnessed vomiting and aspiration of gastric contents following a morning meal. The patient rapidly developed acute respiratory failure, necessitating mechanical ventilation. Ventilatory support failed to oxygenate or ventilate the patient. Extracorporeal membrane oxygenation was instituted. Vitamin C was infused intravenously at 50 mg/kg every 6 hours starting on hospital day 2 with subsequent significant improvement in lung function and lung imaging.
Conclusion: This report adds to the increasing clinical experience employing high dosages of intravenous vitamin C to attenuate the acute inflammatory lung injury. If further adds to the experience of using extracorporeal membrane oxygenation to support lung injured patients.