Sepsis is a life-threatening, often fatal condition that expresses due to the body’s overpowering inflammatory response to the infecting pathogen causing tissue and organ damage. Sadly, fewer than half of American adults have even heard of sepsis, yet, according to the Centers for Disease Control and Prevention, some 1.7 million adults in America develop it, and nearly 270,000 die as a result every year. Data from the CDC reports also shows that 1 in 3 patients who die in the hospital have sepsis. Sepsis is sometimes difficult to diagnose in its early stages as the signs and symptoms are the same as in other conditions, fever, low blood pressure, increased heart rate and difficulty breathing. Standard treatment involves antibiotics, oxygen, and IV fluids to maintain blood flow to organs and tissues, and less often surgery.
According to the Agency for Healthcare Research and Quality and the Healthcare Cost and Utilization Project, sepsis alone is responsible for nearly $24 billion in annual hospital costs and is increasing every year. Finding ways to improve clinical outcomes for sepsis patients could result in significant healthcare cost savings.
So what other options are there besides taking antibiotics? We know now that the recurrent use of antibiotics can alter and disrupt the human microbiome that may lead to other sequela and we are left wondering if there are other effective (more natural) options. Recent research suggests that HAT therapy may be a potential adjunctive therapy to standard sepsis therapy.
According to an article from the American Society of Nutrition, HAT therapy is an evolutionary approach in sepsis management that refers to an intravenous (IV) combination of 50 mg of hydrocortisone every 6 hours, 1500 mg of vitamin C every 6 hours, and 200 mg of thiamine (vitamin B1) every 12 hours that work together to address the dysfunction at a cellular level. Vitamin C and thiamine are widely utilized by the body for various functions, including processes required to survive the septic state.
Post-absorption, the majority of vitamin C is stored in the adrenal glands and utilized during times of stress as a cofactor to synthesize the necessary hormones vasopressin and cortisol. These catecholamines act on glucocorticoid receptors at various tissue sites in order to maintain cellular integrity and function, which ultimately maintains organ function in critically ill patients with sepsis. Another vital role that Vitamin C plays as the body’s primary circulating antioxidant is modulating the immune response by inhibiting NF-kB activation; vitamin C is highly concentrated in white blood cells and platelets. The effective dosing of ascorbic acid for the metabolic resuscitation for septic shock - 6,000 mg per day - requires IV administration due to the limitations of oral absorption. Vitamin C works synergistically with corticosteroids by restoring glucocorticoid receptor function.
Thiamine is a necessary cofactor in several biochemical pathways for mitochondrial energy production. Unfortunately, between 20 and 70% of septic patients have a thiamine deficiency, which leads to significant increases in oxidative stress and free radicals, necrotic cell death, and low energy. Ironically, vitamin B1 deficiency symptoms mimic sepsis. In HAT therapy, thiamine works synergistically with vitamin C to prevent oxalate accumulation. Clinical trials have shown that thiamine is a low-risk intervention for critically ill B1-deficient septic patients for preserving renal function and improved mortality compared to controls. Dosing for metabolic resuscitation is 200 mg two times a day under the supervision of a physician, which is 166 times higher than the current RDA for thiamine.
Funded by the NIH, a novel study published just last month in JAMA is the first randomized, double-blind, placebo-controlled multicenter trial concerning the potential impact that intravenous vitamin C has on acute respiratory distress syndrome (ARDS), a lung disease associated with sepsis that affects individuals worldwide. Although no statistically significant differences were found between the vitamin C and control groups regarding the main study outcome (organ failure scores), the vitamin C group spent significantly fewer days in the intensive care and the hospital overall compared with the placebo group. A major multicenter efficacy trial, “VITAMINS”, is currently underway to determine if a combination of hydrocortisone, vitamin C, and thiamine is a viable therapy to reduce vasopressor dependency in critically ill patients with septic shock compared with hydrocortisone alone. While further research is needed, the results from recent studies are encouraging and may be a promising therapy to battle against sepsis and improve survival rates.