Vitamins in Critical Illness starting now!

Discussing: Vitamin C, Vitamin B12, Vitamin D

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Vitamin B12 up first by Dr. Jayshil Patel.
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There are elevated hydrogen sulfide (H2S) in early sepsis.

As a consequence, H2S induces cytokine activation.

H2S positively correlates with shock severity and mortality.

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How does vitamin B12 play into this?

Dosing is important:

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High-dose B12 mechanism has shown to have elevated blood pressure effects in cyanide and hydrogen sulfide toxicity.

First use of B12 was first used in circulatory shock in the 1960s!!

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Postulated mechanisms:

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Human data is limited to post-operative surgical vasoplegia. Reduction in vasopressor dose and improvement in MAP (single arm studies, observational).

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Side effects of vitamin B12? Generally safe.
Chromaturia and flushing most commonly seen.

Need randomized controlled trials.

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Dr. Todd Rice is up next discussing vitamin D in critical illness.

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Vitamin D is actually a pre-hormone!
(Vitamins are co-factors that must be ingested... who knew?)

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Vitamin D receptors are on nearly every cell type!

Vitamin D deficiency is defined as <20ng/mL

More than half of critically ill patients are vitamin D deficient.

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Is there vitamin D toxicity?
Short answer is rare, wide therapeutic window.

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VITdAL-ICU trial

VIOLET and VIDALIZE are two randomized controlled trials.
VIOLET did not show a mortality benefit with vitamin D.
VIDALIZE is ongoing (some differences in design).

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What about vitamin D and #COVID19 ???

Observational studies showing an association with improvement in outcomes.

Need more studies (41 interventional studies ongoing with vitamin D and COVID-19)

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