535 Vitamin C in the Management of Burn Patients: A Review of Benefits and Risks

Abstract

Introduction Burns are global public health problem. Micronutrients play an essential role in defense mechanisms and immunity. Vitamin C has fostered a growing interest. We reviewed current evidence regarding the effects of Vitamin C on management of burn patients and aims to understand its benefits and risks. Methods A narrative review was performed from January 2000 through September 2020 via PubMed by searching the terms “vitamin C”, “ascorbic acid” and “burns”. The search yielded a total of 170 journal articles. The following were excluded: commentaries, experimental research and studies on non-human subjects. Ultimately, 20 articles qualified for review. Results A total of 924 patients were studied. The literature collectively endorsed a difference in patient outcomes when vitamin C is administered on the first day of admission. The average age across the studies was 15–45 years old. Only 10% of studies included vulnerable age groups (2–15 years old). The Mean Total Body Surface Area (TBSA) of patients was 31%. Most of the studies excluded patients with co-morbidities. The benefits of vitamin C in various aspects of burn management were documented in 70% of studies. Patients who were given vitamin C exhibited a decrease in fluid requirement in 42% of the studies when compared to controls. Additionally, a decrease in wound healing time was reported in 35% of studies, a decreased rate of post-burn infections was reported in 28%, and 14% of studies state that patients given vitamin C had reduced edema. The effect of vitamin C dosing methods on outcomes was also examined. It was reported by 14% of Studies that low-dose Vitamin C infusion does not improve outcomes, while 50% of studies that used high-dose infusion revealed improved results. Additionally, when comparing oral route of administration 20 % of studies used high-dose with favorable results. In regards to risk, oxalate nephropathy, acute kidney injury, and renal failure was documented by six studies. Conclusions Our review concludes that there is decreased fluid requirement, improvement in edema, healing time and post burn infections when high-dose vitamin C (66mg/kg/hr) is given to adults on first day of admission and continuously infused for 24 hours in 1st and 2nd degree burn involving 10 to 40% TBSA. However, there is an associated risk of acute kidney injury and renal failure.

High-dose intravenous versus low-dose oral vitamin C in burn care: potential protective effects in the severely burned: a retrospective cohort study

“…A study by Tanaka and colleagues utilized 66 mg/kg/h of ascorbic acid with a reduction in fluid requirements 5 , 8 . While this dose has shown to be well-tolerated in these studies, there are proposed potential effects of worsening acute kidney injury, osmotic diuresis, and oxalate nephropathy with excess ascorbic acid 9 , 10 . Although ascorbic acid is highly water-soluble and readily excreted by the kidneys, patients with preexisting kidney injury may be overwhelmed by the excess need for excretion.…”