Critical Care and Shock

Hydrocortisone, vitamin C, and thiamine as treatment of septic shock combined with cardiogenic shock: a case report and literature review

Abstract

Objective: To determine whether the concomitant administration of vitamin C, hydrocortisone, and thiamine improves sepsis-related organ failure assessment (SOFA) score and mortality in a patient with septic and cardiogenic shock, multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), gram negative bacteremia, cardiomyopathy, disseminated intravascular coagulation (DIC), and 95% mortality on presentation.

Design: A case report and literature review.

Setting: Surgical Intensive Care Unit at NYU Winthrop Hospital.

Patient: Patient with 95% mortality received appropriate treatment for septic and cardiogenic shock with no clinical improvement.

Intervention: Hydrocortisone 50 mg intravenous push (IVP) every 6 hours for four days, vitamin C 1,500 mg IV every 6 hours for four days, and thiamine 200 mg intravenous piggyback (IVPB) every 12 hours for four days.

Conclusion: Our patient had a remarkable survival of what was thought to be indefinite mortality with the intervention of vitamin C, hydrocortisone, and thiamine. The administration of the vitamin C protocol warrants a randomized controlled trial to change management of septic shock and mortality. We are very optimistic that it will show similar results yielding a significant decrease in mortality rates in patients with septic shock.