Evaluation of High-Dose Ascorbic Acid in Thermal Injury

Burns >20% total body surface area (TBSA) are associated with hypovolemic shock, local tissue edema, and release of inflammatory mediators. Inflammatory mediators lead to production of reactive oxygen species, which can worsen burn shock by causing lipid peroxidation and increased vascular permeability. Ascorbic acid is a free radical scavenger that may reduce lipid peroxidation and vascular permeability by inactivating reactive oxygen species. Ascorbic acid has been shown in animal models and one human clinical trial to reduce fluid requirements in thermal injury. Concerns for osmotic diuresis and risk for renal injury have limited widespread use in burn centers. Conclusion: The addition of AA to fluid resuscitation with LR + albumin did not reduce 24-hour fluid requirements. Ascorbic acid did not statistically increase the risk for renal injury. Patients receiving AA may survive longer, but no difference in mortality versus LR + albumin alone.