Ascorbic Acid - Infusion Data
- This program provides guidance for ascorbic acid infusions based on
the final calculated osmolarity.
Simply select the infusion solution, volume used, and the amount of
ascorbic acid added.
Select a solution:
Lock total volume to amount listed above:
Provide infusion data based on mg/kg?
If yes, enter weight in kilograms:
Enter desired protocol (mg/kg/dose) e.g. 25, 50, 100, 200
If you answered NO above, please enter the desired amount of
Acid for Injection, USP (0.5 grams/mL) in
E.g. 1.5 grams = 3 mL, 3 grams = 6 mL, etc.
NIH - COVID-19 Treatment Guidelines
Vitamin C (ascorbic acid) is a water-soluble vitamin that is
thought to have beneficial effects in patients with severe and
critical illnesses. It is an antioxidant and free radical
scavenger that has anti-inflammatory properties, influences
cellular immunity and vascular integrity, and serves as a
cofactor in the generation of endogenous catecholamines.1,2
Because humans may require more vitamin C in states of oxidative
stress, vitamin C supplementation has been evaluated in numerous
disease states, including serious infections and sepsis. Because
serious COVID-19 may cause sepsis and acute respiratory distress
syndrome (ARDS), the potential role of high doses of vitamin C
in ameliorating inflammation and vascular injury in patients
with COVID-19 is being studied.
Recommendation for Non-Critically Ill Patients With
There are insufficient data for the COVID-19 Treatment
Guidelines Panel (the Panel) to recommend either for or against
the use of vitamin C for the treatment of COVID-19 in
non-critically ill patients.
Because patients who are not critically ill with COVID-19 are
less likely to experience oxidative stress or severe
inflammation, the role of vitamin C in this setting is unknown.
Recommendation for Critically Ill Patients With COVID-19
There are insufficient data for the Panel to recommend either
for or against the use of vitamin C for the treatment of
COVID-19 in critically ill patients.
There are no completed controlled trials of vitamin C in
patients with COVID-19, and the available observational data are
sparse and inconclusive. Studies of vitamin C in sepsis patients
and ARDS patients have reported variable efficacy and few safety
Clinical Data on Vitamin C in Critically Ill Patients
Intravenous Vitamin C Alone:
A small, three-arm pilot study compared two regimens of
intravenous (IV) vitamin C to placebo in 24 critically ill
patients with sepsis. Over the 4-day study period, patients who
received vitamin C 200 mg/kg per day and those who received
vitamin C 50 mg/kg per day had lower sequential organ failure
assessment (SOFA) scores and levels of proinflammatory markers
than patients who received placebo.3
In a randomized controlled trial in critically ill patients with
sepsis-induced ARDS (n = 167), patients who received IV vitamin
C 200 mg/kg per day for 4 days had SOFA scores and levels of
inflammatory markers that were similar to those observed in
patients who received placebo. However, 28-day mortality was
lower in the treatment group (29.8% vs. 46.3%; P = 0.03),
coinciding with more days alive and free of the hospital and the
intensive care unit.4 A post hoc analysis of the study data
reported a difference in median SOFA scores between the
treatment group and placebo group at 96 hours; however, this
difference was not present at baseline or 48 hours.
Previous research has shown that high dose intravenous vitamin C
(HDIVC) may benefit patients with sepsis, acute lung injury
(ALI), and the acute respiratory distress syndrome (ARDS).
However, it is not known if early administration of HDIVC could
prevent progression to ARDS.
We hypothesize that HDIVC is safe and tolerable in Coronavirus
disease 2019 (COVID-19) subjects given early or late in the
disease course and may reduce the risk of respiratory failure
requiring mechanical ventilation and development of ARDS along
with reductions in supplemental oxygen demand and inflammatory
Drug: ascorbic acid
50 mg/kg L-ascorbic acid infusion given every 6 hours for 4 days
(16 total doses)
Despite an organized treatment approach outlined in expert-consensus guidelines for sepsis with fluid resuscitation to treat hypovolemia, antibiotics to target the infectious insult, and vasopressors for hypotension, mortality rates for sepsis remain high and the incidence continues to rise, making sepsis the most expensive inpatient disease.
- Recent research has described the therapeutic benefits associated with ascorbic acid treatment for sepsis.
- Researchers objectives are to perform a randomized-controlled clinical trial investigating the ability of ascorbic acid(vitamin C) administration to decrease organ dysfunction in severe sepsis. The widespread occurrence of microvascular dysfunction in sepsis leading to tissue hypoxia, mitochondrial dysfunction, and ATP depletion, gives rise to organ failure.
- Patients with organ failure and sepsis (severe sepsis) are at a higher risk of death than patients with organ failure alone. Critically ill patients may have an increased requirement for ascorbic acid in sepsis and these patients frequently have levels below normal. Ascorbic acid administration, has been shown to correlate inversely with organ failure (human literature) and directly with survival (animal studies).
Intravenous ascorbic acid therapy decreases organ failure by providing a protective effect on several microvascular functions including improving capillary blood flow, decreasing microvascular permeability, and improving arteriolar responsiveness to vasoconstrictors. Defining the utility of novel agents to augment researchers care for severe sepsis is an important task as investigators continue the institutional focus on sepsis care.
Patients will receive 67 mg/kg IV ascorbic acid in 100 ml
normal saline over 30 minutes every 8 hours (200 mg/kg/day)
for 72 hours.
Mikirova N, Casciari J, Riordan N, Hunninghake R. Clinical
experience with intravenous administration of ascorbic acid:
achievable levels in blood for different states of inflammation and
disease in cancer patients. J Transl Med. 2013;11:191. Published
2013 Aug 15. doi:10.1186/1479-5876-11-191
Consequently, higher doses provide higher plasma concentrations,
but the effect is not linear. This is probably because IVC is
administered as a slow "drip" over a dose-dependent time period
(15 grams are administered over 0.5 hours, while 100 grams are
administered over a 3.5 hours), giving the body more time to
clear some of the ascorbate through the kidneys at higher doses.
Vitamin C is an antioxidant that increases extracellular
collagen production and is important for immune cell
- The intravenous administration of vitamin C involves the
slow infusion of vitamin C at doses on the order of 0.1 to 1.0
grams per kilogram body mass and has become increasingly popular
among complementary and alternative medicine practitioners.
- When vitamin C is given by intravenous infusion, peak
concentrations over 10 mM, two orders of magnitude above what is
observed with oral supplementation, can be attained without
significant adverse effects to the recipient.
For intravenous injection, dilution into a large volume
parenteral such as Normal Saline or Glucose is recommended to
minimize the adverse reactions associated with intravenous
The average protective dose of ascorbic acid for adults is 70 to
150 mg daily. In the presence of scurvy, doses of 300 mg to 1
gram daily are recommended. However, as much as 6 grams have
been administered parenterally to normal adults without evidence
- Package insert: ASCOR (asorbic acid injection), for intravenous use.
McGuff Pharmaceuticals, Inc., Santa Ana, CA 92704. M381-0073.
Accessed: December 02,2020.