Put the lime in the cocoa - Literature Review & Commentary - vitamin C deficiency - Brief Article

Townsend Letter for Doctors and Patients,  Oct, 2002  by Alan R. Gaby

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Twelve patients (aged 46-90 years; mean, 78 years) were identified on a surgical service over a 12-month period who suffered diffuse hemorrhage in the face of normal coagulation parameters and a plasma ascorbic acid level less than 0.6 mg/dl (normal 0.6-2.0 mg/dl). Plasma ascorbic acid levels in these patients were 0.1-0.5 mg/dl (mean, 0.3 mg/dl). Diffuse postoperative bleeding from non-surgical causes was seen in 10 of the 12 patients. Two patients did not have surgical procedures, but were hospitalized for chronic gastrointestinal bleeding. All patients required blood transfusions (mean, 4.8 units; range, 2-13 units). Each patient received 250-1,000 mg/day of vitamin C orally. Within 24 hours of the first dose, there was no further evidence of bleeding and no need for further blood transfusions in any patient.

Comment: This study indicates that vitamin C deficiency severe enough to cause bleeding is relatively common, but frequently overlooked, among surgical patients. Risk factors for vitamin C deficiency include old age, prolonged hospitalization, severe illness, diabetes, poor diet, cigarette smoking, and the use of certain medications. Practice guidelines should include routine supplementation with vitamin C for hospitalized patients who are at risk of being deficient, particularly if they show any evidence of abnormal bleeding.

Blee TH, et al. Hemorrhage associated with vitamin C deficiency in surgical patients. Surgery 2002;131:408-412.

COPYRIGHT 2002 The Townsend Letter Group
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