Effect of Varied Doses of Ascorbic Acid in Burn Patients: A Randomized Controlled Study

Abstract

Background: Free radical-mediated systemic response with fluid and protein leakage from increased capillary permeability is a common feature of oxidative stress in major burn. This work sought to use quantitative urinary protein estimation and serum malondialdehyde to assess the antioxidant efficacy of varied doses of ascorbic acid in burn patients. Materials and Methods: In this double-blind, randomized, controlled prospective study consecutive patients with major burn trauma presenting within 48 hours of the incident at the regional burn centre of National Orthopaedic Hospital, Enugu were recruited. Each burn patient in the treatment group received intravenous ascorbic acid, 2mg/kg/hour or 8mg/kg/hour over 24 hours in lactated Ringers resuscitation fluid. Each patient in the placebo group received 120 mls of Normal saline, in lactated Ringers resuscitation fluid. Oxidative stress status was determined in each patient by quantitative determination of the urinary protein concentration and serum malondialdehyde.  Differences were considered significant when P< 0.05. Results: Twenty-nine out of the forty-eight recruited burn patients had complete data for analysis. The mean age of these patients was 34.6±16.6 years, with mean percentage ‘Total Burn Surface Area’ of 43.7±18.5. Mean decrease in serum malondialdehyde was highest for patients on 8mg/kg/hour of ascorbic acid and the difference was found to be statistically significant, (P<0.001). Similarly, the mean decrease in urinary protein was highest for patients in the 8mg/kg/hour of ascorbic acid group and least for those in the placebo group, (P=0.013). There was no statistically significant correlation between the serum malondialdehyde or urinary protein concentration at presentation and the burns surface area or the patient’s age. Conclusion: Ascorbic acid at a dose of 8mg/kg/hour over 24 hours was superior to 2mg/kg/hour and placebo, in reducing oxidative stress indicators in patients with major burn.