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Clergue-Duval V, Azuar J, Fonsart J, Delage C, Rollet D, Amami J, Frapsauce A, Gautron MA, Hispard E, Bellivier F, Bloch V, Laplanche JL, Questel F, Vorspan F. Ascorbic Acid Deficiency Prevalence and Associated Cognitive Impairment in Alcohol Detoxification Inpatients: A Pilot Study. Antioxidants (Basel) 2021; 10:antiox10121892. [PMID: 34942994 PMCID: PMC8750659 DOI: 10.3390/antiox10121892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/29/2022] Open
Abstract
Malnutrition has been reported in alcohol use disorder patients as having a possible influence on cognitive function. The aim of this study was to analyse the prevalence of ascorbic acid (AA) deficiency in inpatients admitted for alcohol detoxification and the associated factors, including cognitive impairment in the early period of abstinence. A retrospective chart review was conducted. The AA level was categorised into three groups: deficiency (AAD) (<2 mg/L), insufficiency (AAI) (2–5 mg/L) and normal level. The cognitive impairment was screened using the Montreal Cognitive Assessment (MoCA). Ninety-six patients were included (74 men; mean age 49.1 years (±11.5)). Twenty-seven AAD (28.1%) and twenty-two AAI (22.9%) were observed. In multivariate analysis, risk factors for AAD versus normal AA level were men (OR 17.8, 95%CI (1.63–194)), compensated cirrhosis (OR 9.35, 95%CI (1.60–54.6)) and street homelessness (OR 5.76, 95%CI (1.24–26.8) versus personal housing). The MoCA score was available for 53 patients (mean MoCA score: 25.7 (±3.3)). In multivariate analysis, the natural logarithm of AA (β = 1.18, p = 0.037) and sedative use disorder (β = −2.77, p = 0.046) were associated with the MoCA score. AAD and AAI are frequent in inpatients admitted for alcohol detoxification. A low level of AA was associated with cognitive impairment in the early period of abstinence.
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Affiliation(s)
- Virgile Clergue-Duval
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- UFR de Médecine, Université de Paris, 75006 Paris, France
- Resalcog (Réseau Pour la Prise en Charge des Troubles Cognitifs Liés à L’alcool), 75017 Paris, France
- Correspondence:
| | - Julien Azuar
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- Resalcog (Réseau Pour la Prise en Charge des Troubles Cognitifs Liés à L’alcool), 75017 Paris, France
| | - Julien Fonsart
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Biochimie et Biologie Moléculaire, 75010 Paris, France;
| | - Clément Delage
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Service de Pharmacie, 75010 Paris, France;
| | - Dorian Rollet
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
| | - Jihed Amami
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
| | - Alexia Frapsauce
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Service de Pharmacie, 75010 Paris, France;
| | - Marie-Astrid Gautron
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- APHP GHU Nord, Site Beaujon, Unité de Traitement Ambulatoire des Maladies Addictives, 92110 Clichy, France
| | - Eric Hispard
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
| | - Frank Bellivier
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- UFR de Médecine, Université de Paris, 75006 Paris, France
| | - Vanessa Bloch
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Service de Pharmacie, 75010 Paris, France;
- UFR de Pharmacie, Université de Paris, 75006 Paris, France
| | - Jean-Louis Laplanche
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Biochimie et Biologie Moléculaire, 75010 Paris, France;
- UFR de Pharmacie, Université de Paris, 75006 Paris, France
| | - Frank Questel
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- Resalcog (Réseau Pour la Prise en Charge des Troubles Cognitifs Liés à L’alcool), 75017 Paris, France
| | - Florence Vorspan
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, 75010 Paris, France; (J.A.); (D.R.); (J.A.); (E.H.); (F.B.); (F.Q.); (F.V.)
- Inserm UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, 75006 Paris, France; (C.D.); (V.B.); (J.-L.L.)
- FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France;
- UFR de Médecine, Université de Paris, 75006 Paris, France
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Nygaard G. On a Novel, Simplified Model Framework Describing Ascorbic Acid Concentration Dynamics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2880-2886. [PMID: 31946493 DOI: 10.1109/embc.2019.8857675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ascorbic acid is an essential aminoacid which interacts in several parts of the human body metabolism. The ascorbic acid concentration is controlled by homeostasis, a biological, autonomous control function in the body. Humans are not able to produce ascorbic acid, and the ascorbic acid concentration is maintained by daily oral digestion. Ascorbic acid is buffered in various tissues, such as the adrenal glands, brain, muscles, and other. Excessive ascorbic acid is extracted from the body through urine and intestines. Measuring ascorbic acid concentration in the body is challenging, and special procedures must be followed when extracting a blood sample and performing a concentration analysis. This paper presents a novel, simplified model framework of the ascorbic acid homeostasis in the human body plasma and tissues, including tissues such as adrenal glands, brain, liver, muscles and bone marrow. These tissues also act as ascorbic acid concentration buffers, in case of low oral supply. The dynamic model framework is based on mass balances of ascorbate acid in various tissues, including tissue buffer terms involving the intestine, kidney, adrenal glands, and other critical and noncritical tissues. The interaction between buffer tissues and fluids is maintained by the body homeostasis using chemical transport protein molecules. Additional usage terms describing energy metabolism, body growth, and immune system response are also included. This dynamic model framework, including the ascorbic acid concentration control system, is simulated with assumed parameters based on available literature. The results indicates that further investigations using experiments, in addition to adaptive model parameter estimation schemes and additional model verification tests are needed in order to identify the various model framework parameters to fit the human body ascorbic acid homeostasis and pharmacokinetics.
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Marik PE, Liggett A. Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:165. [PMID: 31077227 PMCID: PMC6511125 DOI: 10.1186/s13054-019-2435-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/12/2019] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 423, Norfolk, VA, 23507, USA.
| | - Amanda Liggett
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 423, Norfolk, VA, 23507, USA. .,Department of Medicine, Eastern Virginia Medical School, 721 Fairfax ave, Norfolk, VA, 23507, USA.
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