Summary

Vitamins and minerals act as cofactors for essential processes in health and in illness. The requirements for the healthy person have been well established and are published as the recommended daily requirements (Tables 4 and 5). The exact needs for the infected, injured, or cancer patient are not well documented and evaluations are in progress. Reduced levels of vitamin C, vitamin A, copper, manganese, and zinc have been observed, and all of these are associated with poor wound healing. Wound dehiscence is eight times more common with decreased vitamin C levels. This is probably due to the fact that vitamin C enhances capillary formation and decreases capillary fragility, is a necessary component of complement, and is key to the hydroxylation of proline and lysine in collagen synthesis. Vitamin A enhances collagen synthesis and crosslinking of new collagen, enhances epithe-lialization, and antagonizes the inhibitory effects of glucocorticoids on cell membranes. Manganese is a cofactor in the glycosylation of hydroxylysine in procollagen. Copper acts a cofactor in the polymerization of the collagen molecule and as a cofactor in the formation of collagen crosslinks.

Table 4 Adult daily vitamin nutritional requirements (RDA, 1989)

Nutrient

Oral

Intravenous

Special requirements (diagnosis)

Vitamin A

3300 IU/day

3300 IU/day (1 mg)

5000+ IU/day (serious infections)

Vitamin B (Biotin)

100 mg/day

60 mg/day

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