QUESTION: I have some questions regarding high dose Vit C IVs. Why do we incrementally go up in the dose (opposed to giving the max dose at the first IV)? What is the rationale for all patients to get creatinine/BUN before IVs? My understanding is that it is safe as long as creatinine is under 2. What is the max that the BUN can be? My understanding is that to get true antimicrobial effects, it must be 50-100g IV. We have provided 50g up to this point and would like to go higher. Are there any safety issues or monitoring we must do at such high doses? We have a case where a 65 yo otherwise healthy woman had labs taken very soon after HDIVC and had low GFR (41) and high creatinine (1.52), which resolved 3 days later. We never take labs that soon after an IV, so I wonder if abnormal labs at that time is normal for people or if it indicative of a potential kidney issue (even though it resolved and seems safe). In this woman, would you go up to 100g?
ANSWER: We increase the dose gradually because some people react at lower doses than others. HDIVC is a strain on the RBC’s as well as kidneys etc. Some do fine and some have very bad reactions at lower doses than others. It is a safety thing. Never never draw labs (that involve Ki function or electrolytes within 24 hours after HDIVC. They are all facetious and have no relationship to actual function. I use eGFR for monitoring. CRE is OK but outdated. Safety is why we check as two cases of Ki failure happened when not followed (pre IV screening and monitoring).
It is likely true that antimicrobial effects happen at 50g-100g. Cell support and other benefits happen below 50g certainly. We never “just” use HDIVC in any setting so it is a good tool but almost always needs other Tx. If G6PD is ok, and you monitor eGFR etc etc you can do it safely. Safety at 50-100g is more of an issue with respect to dehydration side effects and kidney stressors.
