Eliana Barbosa, RD, MS, Joel Faintuch, MD, PhD, Emilia Addison Machado Morcria, RD, PhD, Viviane

Rodrigues Goncalves da Silva, RD, Mauricio Jose Lopes Pereima, MD, PhD, Regina Lucia Martins Fagundes, RD, PhD, Danilo Wilhelm Filho, PhD Journal of Burn Care & Research

Imbalance between oxidants and antioxidants

Exacerbation of the inflammatory process
Metabolic deterioration Oxidative damage effects

Skin is the largest organ

Burns result in nutritional, metabolic,

homodynamic, endocrine, & immune inflammatory changes

Pharmacologic replenishment of antioxidant components is not standard care in burn units Despite encouraging results, most antioxidants are still being tested

AIM of this study: --investigate the antioxidant effects of relatively large doses of vitamin C, E, & zinc in burned children

Prospective, randomized, double-blinded Informed consent was obtained from parents Subjects:
32 children admitted at the Burn Unit of the Joana de

Children were placed in either the antioxidant supplementation group (n=17) or the no supplement group (n=15)

Gusmao Childrens hospital Ages 2-15 years Burned area >10% of TBSA (including at least one segment of 2nd degree injury) but not greater than 50% of TBSA Could not have disease or condition that effected energy demand (brain trauma, diabetes mellitus, cancer, etc.)

Administered after meals via syringes

Start from 2nd day of admittance 7 days of administration
Divided into 3 doses (8 am, 1 pm, 6 pm)

Amounts
Vitamin C (1.5 x UL) 1-3 yrs
4-8 yrs 9-13 yrs 14-18 yrs

Vitamin E (1.35x UL) 270 mg

405 mg 810 mg 1080 mg

Zinc (2x RDA) 6 mg

10 mg 16 mg 18 mg (M), 22 mg (F)

600 mg
975 mg 1800 mg 2700 mg

Inflammation: WBC count, lymphocytes, neutrophils, C-reactive protein Renal & Hepatic Function: urea, creatinine, bilirubin ROS: plasma total antioxidant activity & malondialdehyde (MDA) Wound: surgeon-service team looked for presence of a new stable layer of epithelium completely covering the burn, without bleeding, or ulceration

Calculated in days from the time of injury

Groups were comparable

Parameter
Age (mo) Subjects, n Male Female 10 5 1 10 4 16.2 11 6 2 12 3 15.0 .901 .855 .709 .798 .699 .556

No Supplementation
54.3

Antioxidant Supplementation
54.1

P value
.847

Nutritional Status, n
Malnourished or nutritional risk Normal range Overweight or obese % TBSA

Parameter

Reference Values

Placebo: Baseline

Placebo: 7 days

AO: Baseline

AO: 7 days

Significance?

Vitamin C (mg/dL) Vitamin E (mg/dL) Zinc (ug/dL) TAC

0.4-1.5 0.3-1 70-150 1.1-1.2

0.76 0.71 81.43 1.59

2.66

0.76 0.89 75.2 1.49

2.54

0.59 0.50 70.39 1.19

4.49

0.71 1.09 82.92 1.22

3.16

No Yes No No
Yes

MDA Up to 4.8 (nmol/mL)

Markers for immune response had a increase trend for the placebo group & a decrease trend for the AO group

Benefits of the antioxidant supplementation in burned children

Decline lipid peroxidation Maintenance of nutritional antioxidant defenses Strengthens immune system (zinc & vitamin C are

simultaneously immune enhancing) Decreased time of wound healing Another study (Bertin-Maghit et. al) found that patients with severe burn injury who were not supplemented with antioxidants showed enhanced lipoperoxidation levels in plasma

Vitamin C
900 mg would be adequate Study by Tanaka et. al showed that toxicity with

vitamin C is not an issue in the 24 hours following the burn

Vitamin E
Risk of overdose Study by Nathens et. al showed that 300 mg/d for

adults did not cause complications

Zinc
Only massive values (50 mg/day) may cause problems

Refine prescription for the minerals & trace elements Take into consideration more oxidative stress variables Study the effects of these antioxidants on children with burns covering a greater percentage of TBSA