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Critical Care for the Respiratory Specialist: Sepsis, Delirium and Long- Term Cognitive Dysfunction: Prevention with the Combination of Vitamin C, Hydrocortisone and Thiamine

[ Vol. 14 , Issue. 1 ]


Paul E. Marik* and Joseph Varon   Pages 23 - 28 ( 6 )


Objectives: The post-sepsis syndrome characterized by the development of new psychiatric and cognitive deficits occurs in approximately 50% of sepsis survivors. This paper reviews the potential role of glucocorticoids, vitamin C and thiamine in limiting the development of the postsepsis syndrome.

Data Sources and Study Selection: A PubMed literature review was performed for relevant articles. Only articles in English that studied sepsis were included.

Data Extraction and Data Synthesis: Vitamin C is concentrated almost 100-fold in neurons and is the major antioxidant in the brain. Vitamin C deficiency is almost universal in patients with sepsis and increases cerebral oxidant injury, which has been linked to the development of delirium. Furthermore, vitamin C plays an essential role in the synthesis of neurotransmitters and in neuromodulation. Similarly, thiamine deficiency is common in sepsis and thiamine deficiency is well established to be associated with memory and cognitive dysfunction. Glucocorticoids play a central role in the adaptive response to stress, with exogenous glucocorticoid therapy having a proven role in reducing acute delirium and post-traumatic stress syndrome.

Conclusion: We postulate that the treatment of severe sepsis with the combination of vitamin C, hydrocortisone and thiamine in addition to improving the short-term outcome of sepsis may reduce the development of the post-sepsis syndrome.


Anti-oxidant, cognitive dysfunction, corticosteroid, delirium, hydrocortisone, sepsis, thiamine, Vitamin C.


Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, Department of Critical Care Medicine, United Memorial Medical Center, Houston, TX

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