Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2018; 9(12): 206-208
Published online Dec 15, 2018. doi: 10.4239/wjd.v9.i12.206
Role of vitamin C in diabetic ketoacidosis: Is it ready for prime time?
Sebastian Casillas, Alan Pomerantz, Salim Surani, Joseph Varon
Sebastian Casillas, Alan Pomerantz, Dorrington Medical Associates, PA, Houston, TX 77030, United States
Salim Surani, Division of Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Health Science Center, Corpus Christi, TX 78414, United States
Joseph Varon, Acute and Continuing Care, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Joseph Varon, Department of Medicine, the University of Texas, Medical Branch at Galveston, Houston, TX 77030, United States
Joseph Varon, Critical Care Services, United Memorial Medical Center/United General Hospital, Houston, TX 77030, United States
Author contributions: All authors have contributed to the preparation of manuscript, literature search and review for this editorial.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Joseph Varon, FACP, FCCP, MD, Professor, Acute and Continuing Care, The University of Texas Health Science Center at Houston, 2219 Dorrington Street, Houston, TX 77030, United States. joseph.varon@uth.tmc.edu
Telephone: +1-713-6691670 Fax: +1-713-6691671
Received: August 28, 2018
Peer-review started: August 28, 2018
First decision: October 16, 2018
Revised: October 20, 2018
Accepted: November 2, 2018
Article in press: November 3, 2018
Published online: December 15, 2018

Diabetic ketoacidosis (DKA) is life-threatening acute metabolic complication of diabetes mellitus (DM) that is characterized by acidosis, ketosis, and hyperglycemia, currently affecting mostly patients under 30 years of age with diabetes mellitus type 1. In both, DM and DKA, a pro-inflammatory state exists. This clinical entity occurs as a result of hyperglycemia-induced disturbances, resulting in an increased oxidative metabolism. For the latter reason, the use of vitamin C seems promising in DKA due to its antioxidant role in reducing the superoxide radicals that are consequence of the oxidative stress. This can decrease the pro-inflammatory state and avoids complications. Vitamin C, or also known as ascorbic acid, has been widely used in several illnesses, such as common cold, tissue healing, fertility, atherosclerosis, cancer prevention, immunity restoration, neuro-degenerative disease and also has been suggested to decrease the risk of DM, and this reason is giving place to believe that vitamin C can have an important role in treating diabetic complications such as DKA. In order to counteract these oxidative disturbances in DKA patients, we analyzed the current data regarding vitamin C and evaluate its role in any type treatment of this complication in the near future.

Keywords: Vitamin C, Diabetes complications, Ascorbic acid, Diabetic ketoacidosis, Diabetes mellitus

Core tip: The use of vitamin C in diabetic ketoacidosis (DKA) has remained controversial due to insufficient clinical data. The lack of concrete evidence, and no randomized controlled trials available on the use of vitamin C for DKA has caused significant controversies and debate. Some preliminary data, however, has shown a decrease in lipid peroxidation and limitation of endothelial damage. There is a significant need for a large randomized clinical trial to evaluate the role of vitamin C in patients with diabetes mellitus and specifically in those with DKA.