Hydrocortisone, Ascorbic Acid and Thiamine (HAT) as Adjunctive Therapy for the Septic Patient

The CDC estimates that annually 1.7 million Americans develop sepsis and of these cases 270,000 result in death. The annual cost of hospital care for patients with sepsis in the United States was estimated at $14 billion in 2014, with up to 45% of ICU expenses dedicated to managing the disease, and costs are rising. To combat the staggering number of patients affected by sepsis, clinicians continue to investigate novel treatment approaches, however, none have proven to be effective. A treatment approach that has recently gained interest explores the roles that vitamins and steroids play in the body’s response to sepsis. Vitamin C and thiamine, in particular, have been studied alone and in conjunction with each other and hydrocortisone, because of their metabolic roles and their deficiencies observed in the sepsis patient. This review provides a summary of the current literature surrounding the use of vitamin C and thiamine in the treatment of sepsis and describes the function of these essential nutrients in sepsis pathophysiology. Additionally, this review will investigate their combined use with steroids. The aim of this paper seeks to provide clinicians with the necessary understanding to recognize pathophysiological reasoning for the use of vitamin C and thiamine during critical care of the septic patient, as well as their potential therapeutic outcomes