The sodium ascorbate used intravenously and intramuscularly must contain no preservatives. Usually there is only a small amount of EDTA in the preparation to chelate trace amounts of copper and iron which might destroy the ascorbate. Solutions containing sodium ascorbate 250 or 500 mgm per cc can be obtained. The 250 mgm solutions may be used in young children intramuscularly in doses usually 350 mgm/kg body weight up to every 2 hours. When the volume of the material becomes too great for intramuscular injections, then the intravenous route should be used. Inadequate doses will be ineffective. Quite frequently a child initially refusing oral ascorbate will cooperate after injections if given the alternative. While this method of persuasion seems cruel, it is better than the complications which might otherwise occur.
These intramuscular injections can be used in a crisis situation. Kalokerinos (22) describes cases where certain death in infants already in shock has been averted by emergency intramuscular ascorbate. For intravenous solutions concentrations of 60 grams per liter are made with the 250 or 500 mgm/cc sodium ascorbate diluted with Ringer's lactate, 1/2N saline, 1N saline, D5W, or distilled water for injection. I prefer the latter, but one has to be absolutely sure that an error is not made and pure water given. Ascorbate is more efficient intravenously than orally probably because chemical processes in the gut destroy a percentage of that orally administered. Doses of 400 to 700 mgm/kg of body weight per 24 hours usually suffice. Rate of infusion and the total amount administered can be determined by making sure that symptoms are suppressed and that the patient not become dehydrated or receive sodium too rapidly. Local soreness in the vein caused by too rapid infusion is relieved by slowing the intravenous infusion. One gram of calcium gluconate should be added to the bottles each day to prevent tetany.
I have not yet seen a case of phlebitis develop as a result of ascorbate administration. This rarity of phlebitis possibly suggests that this condition sometimes has something to do with ascorbate depletion.
Frequently I have the patient take oral doses of ascorbic acid at the same time he is taking intravenous sodium ascorbate. Bowel tolerance is actually increased by concomitant use of intravenous ascorbate. Care and experience is necessary with concomitant use because tolerance drops precipitously when the intravenous infusion is discontinued.