Vitamin C Administration in Pediatric Patients

Primary Dosing Recommendations

• The American Academy of Pediatrics recommends that preterm and term infants up to 12 months should receive 15-25 mg/kg/day of vitamin C, while older children should receive 80 mg/day 1, 2, 3

Storage and Stability Requirements

• Vitamin C solutions are temperature-sensitive and degrade rapidly at room temperature, and should be stored at 2-8°C for up to 72 hours stability 1, 2, 3
• At 25°C (room temperature), vitamin C becomes unstable after 48 hours 1, 2, 3
• Administer multivitamins with intravenous lipid emulsions to reduce peroxidation and limit vitamin loss 1, 2, 3

Clinical Indications for Injectable Vitamin C

• Parenteral nutrition support is indicated when the enteral route is unavailable 1, 2, 3
• Repletion in inflammatory states requiring higher doses is recommended 4, 5

Special Population Considerations

• Low birth weight infants have less adaptive capacity to high or low vitamin C doses, and may require specific vitamin preparations tailored for low birth weight 1, 2, 3
• Children with kidney disease require dose reduction to prevent oxalate accumulation, with a limit of 100 mg/day for CKD stages 1-4 (not on dialysis) 7

Absolute Contraindications

• Screen for hemochromatosis or iron overload conditions, G6PD deficiency, history of oxalate kidney stones, and severe renal dysfunction (without dialysis support) before administering vitamin C 4, 5, 7

Critical Pitfalls to Avoid

• Never exceed 10 times the dietary reference intake without proven severe deficiency 4
• Do not delay standard sepsis care to administer vitamin C 4
• Monitor for edema if using doses >1 g daily, and monitor electrolytes closely in patients with AKI or CKD receiving kidney replacement therapy 4, 7