Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders.

BACKGROUND: At least a third of the world's population consumes alcohol regularly. Patients with alcohol use disorders (AUDs) are frequently hospitalized for both alcohol-related and unrelated medical conditions. It is well recognized that patients with an AUD are thiamine deficient with thiamine replacement therapy being considered the standard of care. However, the incidence of vitamin C deficiency in this patient population has been poorly defined. METHODS: In this retrospective, observational study, we recorded the admission vitamin C level in patients with an AUD admitted to our medical intensive care unit (MICU) over a 1-year period. In addition, we recorded relevant clinical and laboratory data including the day 2 and day 3 vitamin C level following empiric treatment with vitamin C. Septic patients were excluded from this study. RESULTS: Sixty-nine patients met the inclusion criteria for this study. The patients' mean age was 53 ± 14 years; 52 patients (75%) were males. Severe alcohol withdrawal syndrome was the commonest admitting diagnosis (46%). Eighteen patients (26%) had cirrhosis as the admitting diagnosis with 18 (13%) patients admitted due to alcohol/drug intoxication. Forty-six patients (67%) had evidence of acute alcoholic hepatitis. The mean admission vitamin C level was 17.0 ± 18.1 µmol/l (normal 40-60 µmol/l). Sixty-one (88%) patients had a level less than 40 µmol/l (subnormal) while 52 patients (75%) had hypovitaminosis C (level < 23 µmol/l). None of the variables recorded predicted the vitamin C level. Various vitamin C replacement dosing strategies were used. A 1.5-g loading dose, followed by 500-mg PO q 6, was effective in restoring blood levels to normal by day 2. CONCLUSION: Our results suggest that hypovitaminosis C is exceedingly common in patients with an AUD admitted to an intensive care unit and that all such patients should receive supplementation with vitamin C in addition to thiamine. Additional studies are required to confirm the findings of our observational study and to determine the optimal vitamin C dosing strategy.

Exaggerated responses to stress in the BTBR T+tf/J mouse: an unusual behavioral phenotype.

This study shows that the BTBR T+tf/J mouse, a model for autism spectrum disorder (ASD), has increased levels of the stress hormone corticosterone, when compared to C57BL/6J mice. In addition, we have shown that tail suspension of the BTBR produces a heightened anxiety response in the elevated plus maze. These results suggest that the BTBR mouse is stressor-reactive exhibiting hormone responses that might predispose it to ASD.