Vitamine C in longontsteking en sepsis

05 May, 2020

Door: Fleur Kortekaas

Over het nut van vitamine C-suppletie bij Covid-19 zijn de meningen zeer verdeeld. Toch zijn in Chinese en Amerikaanse ziekenhuizen opmerkelijke resultaten geboekt met hoge doses vitamine C bij ernstige longontsteking en sepsis. Er zijn inmiddels ook Covid-19-protocollen ontwikkeld voor de inzet van vitamine C.

Profylactische toediening van vitamine C (minstens 200 mg per dag) bij reeds geïnfecteerde (griep)patiënten verminderde de incidentie van longontsteking.2-5 Het lijkt erop dat hoe lager de vitamine C-status is, des te ernstiger de ernst van de longontsteking of ARDS.6,7 Zeker 40% van de patiënten vertoonden vitamine C-deficiëntie (minder dan 11 micromol/L), en die niveaus bleven gedurende vier weken verlaagd.8,9 Uit deze studies blijkt een hoger gebruik van vitamine C, en mogelijk ook een hogere behoefte aan vitamine C gedurende lage luchtweginfecties.
Een eerste rapport van de arts Kenner in 1948 liet zien dat toediening van 2 tot 4 gram vitamine C per dag intraveneus of intramusculair bij patiënten met longontsteking de hoofdpijn, misselijkheid, koorts en cyanose verminderde.10 Orale of intraveneus toegediende vitamine C bleek in onderzoek de ernst van de luchtwegklachten te doen afnemen, met name in de meest zieke patiënten, en de verblijfsduur in het ziekenhuis te verminderen.8,9

Cathart opperde de hypothese dat patiënten met ernstige luchtweginfecties en longontsteking een hogere behoefte aan vitamine C hadden. Hij deed dat op basis van de observatie dat de patiënten vitamine C in de darm verdroegen bij doseringen van 4-15 gram per 24 uur.11 Mochalkin observeerde op basis van het monitoren van vitamine C-niveaus dat 250-800 mg vitamine C per dag onvoldoende was om de initiële vitamine C-status van de patiënt te behouden. Maar 500 tot 1600 mg per dag bleek wél voldoende te zijn.9 Deze niveaus waren niettemin nog steeds te laag (minder dan 50 micromol/L), wat suggereert dat meer dan 1600 mg per dag nodig is om het plasma te verzadigen. Hieruit kan worden afgeleid dat patiënten met ernstige infecties zoals longontsteking een hogere behoefte hebben aan vitamine C en dat toediening van deze dosis leidt tot verbetering van het klinisch verloop van de infectie.1

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