Ascorbic acid dynamics in the seriously ill and injured

J Surg Res. 2003 Feb;109(2):144-8. doi: 10.1016/s0022-4804(02)00083-5.


Background: In addition to the known beneficial effects of ascorbic acid on wound healing and the immune response, it is also a potent extracellular antioxidant. Recent work in septic rats suggests that high-dose ascorbic acid total parenteral nutrition (TPN) supplementation may protect cells from free radical injury and improve survival. In this study, we determined ascorbic acid levels in the immediate post-injury/illness period and evaluated the ability of early short-term high levels of ascorbic acid in TPN to normalize plasma levels.

Materials and methods: Ascorbic acid levels were determined in 12 critically injured patients and 2 patients with severe surgical infections. Each patient received TPN supplemented with increasing doses of ascorbic acid over a 6-day period. Therapeutic responses were determined by plasma and urine measurements using high-pressure liquid chromatography.

Results: The initial mean +/- SEM baseline plasma ascorbic acid concentration was depressed (0.11 +/- 0.03 mg/dl) and unresponsive following 2 days on 300 mg/day supplementation (0.14 +/- 0.03; P = 1.0) and only approached low normal plasma levels following 2 days on 1000 mg/day (0.32 +/- 0.08; P = 0.36). A significant increase was noted following 2 days on 3000 mg/day (1.2 +/- 0.03; P = 0.005).

Conclusion: We confirmed extremely low plasma levels of ascorbic acid following trauma and infection. Maximal early repletion of this vitamin requires rapid pool filling early in the post-injury period using supraphysiologic doses for 3 or more days.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Antioxidants / metabolism
  • Antioxidants / pharmacokinetics*
  • Antioxidants / therapeutic use*
  • Ascorbic Acid / blood
  • Ascorbic Acid / pharmacokinetics*
  • Ascorbic Acid / therapeutic use*
  • Ascorbic Acid / urine
  • Critical Illness / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Parenteral Nutrition, Total*
  • Sepsis / complications
  • Sepsis / metabolism*
  • Sepsis / therapy
  • Time Factors
  • Wounds and Injuries / complications
  • Wounds and Injuries / metabolism*
  • Wounds and Injuries / therapy


  • Antioxidants
  • Ascorbic Acid