Reduction of Resuscitation Fluid Volumes in Severely Burned Patients Using Ascorbic Acid Administration

Abstract

High-dose ascorbic acid (vitamin C) therapy (66 mg/kg per hour) attenuates postburn lipid peroxidation, resuscitation fluid volume requirements, and edema generation in severely burned patients. Study Design and Setting:A prospective, randomized study at a university trauma and critical care center in Japan.Subjects and Methods: Thirty-seven patients with burns over more than 30% of their total body surface area (TBSA) hospitalized within 2 hours after injury were randomly divided into ascorbic acid and control groups. Fluid resuscitation was performed using Ringer lactate solution to maintain stable hemodynamic measurements and adequate urine output (0.5-1.0 mL/kg per hour). In the ascorbic acid group (n = 19; mean burn size, 63% ± 26% TBSA; mean burn index, 57 ± 26; inhalation injury, 15/ 19), ascorbic acid was infused during the initial 24hour study period. In the control group (n = 18; mean burn size, 53% ± 17% TBSA; mean burn index, 47 ± 13; inhalation injury, 12/18), no ascorbic acid was infused. We compared hemodynamic and respiratory measurements, lipid peroxidation, and fluid balance for 96 hours after injury. Two-way analysis of variance and Tukey test were used to analyze the data.

Evaluation of Vitamin C for Adjuvant Sepsis Therapy

“…This concentration is equal to the plasma ascorbate concentration achieved by an ascorbate infusion protocol that lessens edema formation in burn patients (57). For the ascorbate and DHAA treatments in cell cultures, the protection of the endothelial barrier is associated with increased intracellular ascorbate concentration and it depends on inhibition of both peroxynitrite formation and PP2A nitration/ activation (24).…”

“…The first of these 2 trials found that infusion i.v. of ascorbate [1584 mg/(kg.day)] decreases edema and improves respiratory function in severely burned patients (57). This trial is relevant because, first, there are similarities between the systemic inflammatory responses to septic insults and burn injury, and second, a major cause of death in severely burned patients is multiorgan failure due to sepsis.…”

“…Further, i.v. infusion of high-dose ascorbate [1584 mg/ (kg.day) for 3 days] lowers serum malondialdehyde concentration in severely burned patients, indicating that the vitamin decreases the oxidative stress associated with the systemic inflammatory response to burn injury (57). High-dose ascorbate also decreases postsurgical oxidative stress.…”

Immunonutrition: a South African perspective

“…The length of mechanical ventilation was also significantly reduced and improved early respiratory function was observed. 112 Other micronutrients that have received attention in recent years include vitamin D and vitamin B 12 . Vitamin D deficiency states have been described in patients with severe sepsis and other critically ill populations 113,114 with low levels of vitamin D-binding hormone being reported.…”

State of the Science Meeting: Burn Care: Goals for Treatment and Research

“…The clinical studies, performed in Japan, suggest that Vitamin C treatment might be an inexpensive and effective means for reducing fluid requirements for burn patients 84 . These studies have not been duplicated in other institutions.…”