Vitamin C Infusion for Gastric Acid Aspiration-Induced Acute Respiratory Distress Syndrome (ARDS)
DOI:
https://doi.org/10.17140/PRRMOJ-4-136Keywords:
Intravenous vitamin C, Acute respiratory distress syndrome, Extracorporeal membrane oxygenation, Acute respiratory failure, Gastric acid aspirationAbstract
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.
References
Beck-Schimmer B, Bonvina JM. Bronchoaspiration: Inci-dence, consequences, and management. Eur J Anaesthesiol. 2011; 28(2): 78-84. doi: 10.1097/EJA.0b013e32834205a8
Sawyer MAJ, Mike JJ, Chavin K. Antioxidant therapy and survival in ARDS [Abstract]. Crit Care Med. 1989; 17: S153.
Nathens AB, Neff MJ, Jurkovich GJ, et al. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg. 2002; 236(6): 814-822. 10.1097/ 00000658-200212000-00014
Tanaka H, Matsuda T, Miyagantani Y, Yukioka T, Matsuda H, Shimazaki S. Reduction of resuscitation fluid volumes in se-verely burned patients using ascorbic acid administration: A ran-domized, prospective study. Arch Surg. 2000; 135 (3): 326-331. doi: 10.1001/archsurg.135.3.326
Fowler AA, Syed AA, Knowlson S, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014; 12: 32. doi: 10.1186/1479-5876-12-32
Fisher BJ, Seropian IM, Kraskauskas D, et al. Ascorbic acid attenuates lipopolysaccharide-induced acute lung inju-ry. Crit Care Med. 2011; 39: 1454-1460. doi: 10.1097/CCM. 0b013e3182120cb
Fisher BJ, Kraskauskas D, Martin EJ, et al. Attenuation of sepsis induced organ injury by vitamin C. JPEN J Parenter En-teral Nutr. 2014; 38: 825-839. doi: 10.1177/0148607113497760
Fisher BJ, Kraskauskas D, Martin EJ, et al. Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid. Am J Physiol Lung Cell Mol Physiol. 2012; 303: L20-L32. doi: 10.1152/ajplung.00300.2011
Kennedy TP, Johnson KJ, Kunkel RG, Ward PA, Knight PR, Finch JS. Acute acid aspiration lung injury in the rat: Biphasic pathogenesis. Anesth Analg. 1989; 69(1): 87-92.
Goldman G, Welbourn R, Kobzik L, Valeri CR, Shepro D, Hechtman HB. Reactive oxygen species and elastase mediate lung permeability after acid aspiration. J Appl Physiol. 1992; 73(2): 571-575.
Mohammed BM, Fisher BJ, Kraskauskas D, et al. Vitamin C: A novel regulator of neutrophil extracellular trap formation. Nutrients. 2013; 5(8): 3131-3151. doi: 10.3390/nu5083131
Semeraro N, Ammollo CT, Semeraro F, et al. Coagulopathy of acute sepsis. Semin Thromb Hemost. 2015; 41(6): 650-658. doi: 10.1055/s-0035-1556730
Berger MM, Oudemans-van Straaten HM. Vitamin C supple-mentation in the critically ill patient. Curr Opin Clin Nutr Metab Care. 2015; 18: 193-201. doi: 10.1097/MCO.0000000000000148
Wetsch WA, Spöhr FA, Hinkelbein J, et al. Emergency extracorporeal membrane oxygenation to treat massive aspi-ration during anaesthesia induction. A case report. Acta An-aesthesiol Scand. 2012; 56(6): 797-800. doi: 10.1111/j.1399- 6576.2012.02697.x
Zhao JN, Liu Y, Li HC. Corticosteroids in treatment of aspi-ration-related acute respiratory distress syndrome: Results of a retrospective cohort study. BMC Pulm Med. 2016; 16: 29. doi: 10.1186/s12890-016-0194-4
Bharara A, Grossman C, Grinnan D, et al. Intravenous vi-tamin C administered as adjunctive therapy for recurrent acute respiratory distress syndrome. Case Rep Crit Care. 2016; 2016: 8560871. doi: 10.1155/2016/8560871
Fowler AA, Kim C, Lepler L, et al. Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute re-spiratory distress syndrome. World J Crit Care Med. 2017; 6(1): 85-90. doi: 10.5492/wjccm.v6.i1.85
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Pulmonary Research and Respiratory Medicine (PRRM) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
