Vitamins

Specific vitamin requirements in burns patients have not been established, but levels may decline in the hypermetabolic state. As a minimum, the recommended daily allowance should be given following injury. For minor burns of 10-20% body surface area, supplementation with a single multivitamin tablet orally should replace vitamin losses sustained during injury. For larger burns, additional supplementation is advised, especially vitamin C (ascorbic acid), which is of benefit in wound healing and has experimentally been shown to possess free radical scavenging properties that may help to limit tissue damage. A recommended dose is 1 g daily in two divided doses for all patients with major burns; children younger than age 3 years should receive half this dose daily. The essential, fat-soluble, vitamin A may also confer some advantages in wound healing and immunomodulation. A dose of 10 000IU daily is recommended for all patients with major burns who are older than the age of 3 years; younger children should receive half this amount daily. Wherever possible, both vitamin and micronutrients should be administered by the enteral route. If such supplements are added to total parenteral nutrition (TPN), dosing schedules should take into account the increased bioavailablity via this route and a dose reduction may be advisable. Monitoring of levels of micronutrients should guide replacement by the parenteral route.

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