Effect of high-dose intravenous vitamin C on point-of-care blood glucose level in septic patients: a retrospective, single-center, observational case series

Abstract

Introduction

High-dose vitamin C is an essential adjunctive drug for sepsis treatment. This study aimed to determine if high-dose vitamin C could lead to erroneous point-of-care glucose testing results.

Methods and materials

This retrospective, single-center, observational case series involved septic patients treated with high-dose vitamin C. We monitored their paired point-of-care glucose and laboratory glucose levels for statistical analysis. The glucose oxidase-peroxidase colorimetric method and hexokinase spectrophotometric method were applied for point-of-care glucose and laboratory glucose monitoring, respectively. Parkes Consensus Error Grid Analysis was used to assess the clinical influence of paired blood glucose values. Subgroup analyses were conducted to explore the effect of different vitamin C dosages and various renal function levels on point-of-care glucose readings.

Results

During a 3-year period, 82 eligible septic patients who accepted at least three days of high-dose vitamin C treatment were included in this study. Compliance with ISO15197:2013 criteria was met in 30 (36.59%) paired values, a proportion considerably lower than the minimum criteria for accuracy. Subgroup analysis showed that worse renal function or higher vitamin C dosage could lead to greater bias in point-of-care glucose readings; however, these inaccuracies rarely represented a clinical risk.

Conclusions

High-dose intravenous ascorbate acid infusion may interfere with point-of-care glucose testing results. Thus, laboratory glucose measurements are recommended for more accurate results. Nonetheless, the inaccuracies magnitude of point-of-care glucose readings does not represent a significant clinical risk when physicians alter clinical action based on these results.

Keywords:

• Vitamin C
• point-of-care
• glucose
• sepsis

Transparency

Declaration of funding

This study was supported by Shanghai Shen Kang Hospital Development Center Clinical Science and technology innovation project (No. SHDC12017116) and Important and weak discipline construction plan for health and family planning system of Shanghai (No. 2016ZB0206).

Declaration of financial/other relationships

All authors declared no financial or other relationships in this study should be declared in this paper. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

GZ, JH and XB had full access to all data in the study and take responsibility for the integrity and the accuracy of the data analysis; they contributed equally to the manuscript. GZ, JH and XB conceived and designed this study, participated in study design and coordination, and helped to draft the manuscript. GZ, JH, XQ, BZ, HS, XB, BC, EC and EM collected the information, and contributed to the acquisition, analysis and interpretation of the data. GZ, JH and XB wrote and revised the manuscript. All authors read and approved the final manuscript.

Acknowledgements

The authors thank the staff of the EICU Department of Ruijin Hospital affiliated to Medical School of Shanghai Jiao Tong University for their facilities and collaboration.