Marik´s cocktail or HAT therapy (hydrocortisone, Vitamin C and Thiamine) in sepsis. Critical review and current controversies in a case report.
DOI:
https://doi.org/10.30445/rear.v13i4.898Keywords:
septic shock, Vitamin C, CThiamine, ThiamineSteroidsAbstract
Marik et al (2017) propose that the combination of hydrocortisone, intravenous ascorbic acid, and thiamine (HAT therapy) is an effective therapy for sepsis. This protocol which targets multiple components of the host's response to an infectious agent, will synergistically, restore the dysregulated immune response and thereby prevent organ failure and death. Paul Marik’s suggestions that this combination is a cure all for sepsis. HAT therapy is based on the concept that combinations of readily available, safe and cheap agents. The Marik protocol has been adopted by critical care unit in the worldwide. Vitamins multicentric study (2020) claims to provide evidence that the vitamin cocktail is not superior to usual care with hydrocortisone alone.
References
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- Fowler AA, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA 2019 1; 322(13):1261-1270.
- Mitchell AB, Ryan TE, Gillion AR, Wells LD, Muthiah P. Vitamin C and Thiamine for Sepsis and Septic Shock. Am J Med 2019 Aug 28. pii: S0002-9343(19)30699-0. doi: 10.1016/j.amjmed.2019.07.054.
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- Mühlhöfer A, Mrosek S, Schlegel B, Trommer W, Rozario F, Böhles H, et al. High-dose intravenous vitamin C is not associated with an increase of pro-oxidative biomarkers. Eur J Clin Nutr 2004; 58(8):1151-8.
- Kim WY, Jung JW, Choi JC, Shin JW, Kim JY. Subphenotypes in Patients with Septic Shock Receiving Vitamin C, Hydrocortisone, and Thiamine: A Retrospective Cohort Analysis. Nutrients 2019; 11(12). pii: E2976. doi: 10.3390/nu11122976.
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- Carr AC, Rosengrave PC, Bayer S, et al. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Crit Care 2017; 21(1):300. doi: 10.1186/s13054-017-1891-y.
- Marik PE. Patterns of Death in Patients with Sepsis and the Use of Hydrocortisone, Ascorbic Acid, and Thiamine to Prevent These Deaths. Surg Infect (Larchmt) 2018; 19(8):812-820.
- Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, vitamin C and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest 2017; 151(6):1229–1238.
- Marsilio NR, Silva Dd, Bueno D. Drug incompatibilities in the adult intensive care unit of a university hospital. Incompatibilidades medicamentosas em centro de tratamento intensivo adulto de um hospital universitário. Rev Bras Ter Intensiva 2016; 28(2):147–153.
- Keh D, Trips E, Marx G, Wirtz SP, Abduljawwad E, Bercker S et al. Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial. JAMA 2016 Nov 1; 316(17):1775-1785.
- Lin LL, Gu HY, Luo J, Wang L, Zhang C, Niu YM, Zuo HX. Impact and beneficial critical points of clinical outcome in corticosteroid management of adult patients with Sepsis: Meta-Analysis and GRADE Assessment. Front Pharmacol 2019 Sep 24; 10:1101. doi: 10.3389/fphar.2019.01101. eCollection 2019.
- Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, et al. Randomized, double-blind, placebo-controlled trial of thiamine as a metabolic resuscitator in septic shock: a pilot study. Crit Care Med 2016; 44(2):360–367.
- Moskowitz A, Andersen LW, Cocchi MN, Karlsson M, Patel PV, Donnino MW. Thiamine as a renal protective agent in septic shock. a secondary analysis of a randomized, double-blind, placebo-controlled trial. Ann Am Thorac Soc 2017; 14(5):737–741.
- Fowler AA, 3rd, Syed AA, Knowlson S, Sculthorpe R, Farthing D, DeWilde C, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med 2014; 12:32.
- Zabet MH, Mohammadi M, Ramezani M, Khalili H. Effect of high-dose Ascorbic acid on vasopressor's requirement in septic shock. J Res Pharm Pract 2016; 5(2):94–100.
- Fowler AA, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA 2019 1; 322(13):1261-1270.
- Mitchell AB, Ryan TE, Gillion AR, Wells LD, Muthiah P. Vitamin C and Thiamine for Sepsis and Septic Shock. Am J Med 2019 Aug 28. pii: S0002-9343(19)30699-0. doi: 10.1016/j.amjmed.2019.07.054.
- Hudson EP, Collie JT, Fujii T, Luethi N, Udy AA, et al. Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock. Crit Care Resusc 2019; 21(4):236-42.
- Mühlhöfer A, Mrosek S, Schlegel B, Trommer W, Rozario F, Böhles H, et al. High-dose intravenous vitamin C is not associated with an increase of pro-oxidative biomarkers. Eur J Clin Nutr 2004; 58(8):1151-8.
- Kim WY, Jung JW, Choi JC, Shin JW, Kim JY. Subphenotypes in Patients with Septic Shock Receiving Vitamin C, Hydrocortisone, and Thiamine: A Retrospective Cohort Analysis. Nutrients 2019; 11(12). pii: E2976. doi: 10.3390/nu11122976.
- Moskowitz A, Yankama T, Andersen LW, Huang DT, Donnino MW, Grossestreuer AV; ACTS Clinical Trial Investigators. Ascorbic Acid, Corticosteroids and Thiamine in Sepsis (ACTS) protocol and statistical analysis plan: a prospective, multicentre, double-blind, randomised, placebo-controlled clinical trial. BMJ Open 2019; 17; 9(12):e034406. doi: 10.1136/bmjopen-2019-034406.
- Hager DN, Hooper MH, Bernard GR, Busse LW, Ely EW, Fowler AA, et al. The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) Protocol: a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial. Trials 2019; 5; 20(1):197. doi: 10.1186/s13063-019-3254-2.
- Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, et al; VITAMINS Trial Investigators. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA 2020 Jan 17. doi: 10.1001/jama.2019.22176.
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Published
2021-05-10
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Sáenz, M. C., González, D. R., Orrego, A. G., & Martín, J. S. (2021). Marik´s cocktail or HAT therapy (hydrocortisone, Vitamin C and Thiamine) in sepsis. Critical review and current controversies in a case report. Revista Electrónica AnestesiaR, 13(4). https://doi.org/10.30445/rear.v13i4.898
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