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Vitamin C requirement in surgical patients

Fukushima, Ryoji; Yamazaki, Eriko

Current Opinion in Clinical Nutrition and Metabolic Care: November 2010 - Volume 13 - Issue 6 - p 669–676
doi: 10.1097/MCO.0b013e32833e05bc
Micronutrients: Edited by Henry C. Lukaski and Gil Hardy

Purpose of review To summarize recent findings on vitamin C status and assess the requirement and optimal dose of supplementation in surgical patients.

Recent findings Blood vitamin C concentration falls after uncomplicated surgery and further decreases in surgical intensive care unit patients. The decline may be owing to increased demand caused by increased oxidative stress. To normalize plasma vitamin C concentration, much higher doses than the recommended daily allowance or doses recommended in parenteral nutrition guidelines are needed in these patients. In uncomplicated surgical patients, more than 500 mg/day of vitamin C may be required, with much higher doses in surgical intensive care unit patients. In uncomplicated gastrointestinal surgery, continuous parenteral administration of 500 mg/day of vitamin C reduced postoperative oxidative stress as manifested by reduced urinary excretion of isoprostane. In some studies, postoperative atrial fibrillation was prevented after cardiac surgery by perioperative vitamin C supplementation. In critically ill patients, some prospective randomized controlled trials support parenteral supplementation of high doses of vitamin C, E and trace elements.

Summary Vitamin C requirement is increased in surgical patients, and the potential advantage of supplementation is to increase the plasma and tissue levels of vitamin C and thereby reduce oxidative stress. Although some clinical benefits of high-dose vitamin C supplementation have been shown in the critically ill, the optimal dose for supplementation and the clinical benefits remain to be investigated in surgical patients.

Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan

Correspondence to Dr Ryoji Fukushima, MD, PhD, Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173 8605, Japan Tel: +81 3 3964 1231; fax: +81 3 5375 6097; e-mail: ryojif@med.teikyo-u.ac.jp

© 2010 Lippincott Williams & Wilkins, Inc.