Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute respiratory distress syndrome.

We report a case of virus-induced acute respiratory distress syndrome (ARDS) treated with parenteral vitamin C in a patient testing positive for enterovirus/rhinovirus on viral screening. This report outlines the first use of high dose intravenous vitamin C as an interventional therapy for ARDS, resulting from enterovirus/rhinovirus respiratory infection. From very significant preclinical research performed at Virginia Commonwealth University with vitamin C and with the very positive results of a previously performed phase I safety trial infusing high dose vitamin C intravenously into patients with severe sepsis, we reasoned that infusing identical dosing to a patient with ARDS from viral infection would be therapeutic. We report here the case of a 20-year-old, previously healthy, female who contracted respiratory enterovirus/rhinovirus infection that led to acute lung injury and rapidly to ARDS. She contracted the infection in central Italy while on an 8-d spring break from college. During a return flight to the United States, she developed increasing dyspnea and hypoxemia that rapidly developed into acute lung injury that led to ARDS. When support with mechanical ventilation failed, extracorporeal membrane oxygenation (ECMO) was initiated. Twelve hours following ECMO initiation, high dose intravenous vitamin C was begun. The patient's recovery was rapid. ECMO and mechanical ventilation were discontinued by day-7 and the patient recovered with no long-term ARDS sequelae. Infusing high dose intravenous vitamin C into this patient with virus-induced ARDS was associated with rapid resolution of lung injury with no evidence of post-ARDS fibroproliferative sequelae. Intravenous vitamin C as a treatment for ARDS may open a new era of therapy for ARDS from many causes.

Hemoptysis in a 28-year-old active duty soldier.

A 28-year-old African American male, originally from West Africa, presented with complaints of cough and hemoptysis. This case follows the patient through transfer to Walter Reed Army Medical Center and outpatient follow-up. Exploring this case illustrates how an Army physician may approach a soldier with hemoptysis. Additionally, this case demonstrates the management and treatment of his condition.

Responding to and managing casualties: detection, personal protection, and decontamination.

Unfortunately, a mass casualty caused by chemical or biologic terrorism has become a real threat to the United States. A well-considered preparedness plan is needed to minimize tOe impact of a chemical or biologic attack on civilians and responders. This article describes some of the key elements in a preparedness plan, specifically issues regarding early detection, decontamination. and personal protection. Although chemical and biologic terrorism is often considered as a single entity, there are important distinctions in detection, decontamination, and personal protection procedures that effect preparedness planning. Therefore, any preparedness plan needs to be flexible enough to deal with both biologic and chemical terrorism. Preparedness plans also need to be thorough enough to deal with the differences in response to a variety of specific chemical or biologic agents.