Shock is a very dangerous condition of general bodily collapse that can rapidly appear as a result of the stresses of severe, traumatic injuries, burns, major surgery, massive hemorrhage, abdominal injury, and dehydration. The fundamental defect in shock is failure of effective blood flow and hence impaired transport of vital materials in the blood to the organs and tissues. This is brought on by increased permeability of the capillaries, resulting in loss of blood plasma into the surrounding tissues.
The lowered blood volume, with its increased percentage of blood cellular constituents, is more difficult to pump through the arteries and veins. The volume of blood being pumped from the heart is low and the blood pressure is low. The patient is usually in a state of collapse with a pallid, moist skin and impaired mental faculties.
The use of ascorbate in the treatment of shock has been repeatedly suggested in many papers over the past thirty years.
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These papers include reports not only of successful experiments on laboratory animals, but on case histories on man. There is a perfectly good rationale for this use of ascorbate because of its long-known beneficial effects in preventing capillary fragility and the fact that hemorrhage is a characteristic symptom of ascorbate depletion.
Ungar 4 , in and , was able to prevent traumatic shock and death in injured guinea pigs by an injection of ascorbate of milligrams or more per kilogram of body weight. In , nearly three decades ago, he noted that particular emphasis should be laid on the possibility of utilizing his observations in the treatment of human traumatic and surgical shock. Further tests on guinea pigs, reported in by McDevitt and coworkers 4 , showed ascorbate increased their resistance to trauma and improved their survival.
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Of the eleven cases, five had subnormal ascorbate levels before the operation and eight had levels markedly below normal immediately postoperatively or within twenty-four hours. Hemorrhagic shock induced in guinea pigs by a standardized bleeding procedure was the subject of a paper by de Pasqualini 4. She found that if the guinea pigs were given milligrams of ascorbate five minutes before the start of bleeding, it prevented shock and 94 percent of her eighteen test animals survived, while 90 percent of the seventeen animals not given ascorbate died.
Holmes 5 , in , discussed the use of ascorbate to relieve the increased capillary permeability occurring in shock.
He cites the successful results of a group of cooperating surgeons using ascorbate to successfully treat surgical shock. Another surgeon used it successfully preoperatively and postoperatively in fifty serious abdominal operations. In approximately 2, cases of dental extractions, ascorbate was administered thirty to forty-five minutes before the extraction, preventing shock and postoperative weakness. It was also employed in thirty-five cases of mine injuries, in which instances it helped the injured to survive the long trip to the hospital.
He also cites the experience of other cooperating physicians. He noted that there was no question on the value of adequate amounts of ascorbate in the maintenance of a healthy condition of the capillary walls and that it may also be useful in combating the anoxia of shock. The highest blood levels of ascorbate were reached after two or three hours on oral administration and in three to five minutes when given intravenously. In , S. Levenson and associates 6 , reported on the use of ascorbate, vitamins B1, and B2, and nicotinic acid in severe injury, hemorrhage, and infections in humans.
They concluded that their work adds further support to the idea that large doses of these materials may serve a useful purpose in treating acutely ill patients. In , a conference and workshop on hemorrhagic shock was held at the Rockefeller Institute.
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As reported in Science by Simeone 6 , Dr. Levenson presented a paper revealing that injured animals suffer for biochemical scurvy. In , Zerbine 7 , reported on a duodenal ulcer operation where the patient went into postoperative shock. Prompt administration of 2 grams of ascorbate, intravenously, pulled him out of the shock within minutes. Kashchevskaia 7 , in a paper from the Soviet Union, showed that ascorbate is intimately involved in the state of shock.click here
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Strawitz and coworkers 8 , using rats to determine the effect of ascorbate and methylene blue in hemorrhagic shock, reported in that both agents significantly reduced the mortality rates and, in addition, ascorbate lengthened the survival period. They found an increase in the blood ascorbate levels and a highly significant decrease in the blood ascorbate levels and a highly significant decrease in the adrenal gland ascorbate, in spite of the higher levels in the blood. The higher blood level is likely to be an artifact because the liver rapidly synthesized ascorbate under the stress and it poured it into a reduced volume of blood.
The low ascorbate levels in the adrenal glands are probably a more reliable criteria of the response to the heavy stresses to which the animals were subjected. In a paper published in , Kocsard-Varo 9 discussed microcirculation the capillary system , capillary permeability, and ascorbate. She made the following interesting observations which involved her in the study of the microcirculation. She found that in nosebleed due to high blood pressure, if a , adrenaline solution were applied to the surface of the nasal mucous membrane or if ascorbate were injected individually, the bleeding would continue.
The bleeding does not recur. The electron microscope studies of the capillary bed of ascorbate-deficient guinea pigs, by Gore and coworkers 10 , published in , disclosed the ultrastructural basis for the capillary defects, the microdiscontinuities and microlesions which lead to capillary fragility. The above review of the highly suggestive research over the past three decades illustrates the possible usefulness of ascorbate in the prevention and treatment of traumatic, hemorrhagic, and surgical shock.
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