Abstract | March 2, 2021

Outcome Evaluation of High Dose Ascorbic Acid Infusion in Adult Burn Patients

Presenting Author: Dominick Curry, PharmD, Warder Burn Center, Orlando Regional Medical Center, Orlando, FL

Co-Authors: Susan Smith, ARNP, Orlando Regional Medical Center, Orlando, FL Brandon Hobbs, PharmD, Orlando Regional Medical Center, Orlando, FL Howard Smith, MD, Orlando Regional Medical Center, Orlando, FL

Learning Objectives

  1. Describe the incidence of renal replacement therapy in patients receiving high dose ascorbic acid for burn resuscitation;
  2. Measure the effect of high dose ascorbic acid on the fluid requirements during resuscitation;
  3. Examine the rate of resuscitation-related complications while utilizing high dose ascorbic acid for burn resuscitation.

Introduction: High dose ascorbic acid (HDAA) infusion has been associated with lower resuscitation volumes following severe burn injuries. Recent data has linked the use of HDAA to an increased risk of renal failure. HDAA infusion causes an osmotic diuresis which confounds fluid titration. For these two reasons, HDAA has become controversial. The objective of this study is to examine the outcomes of adult burn patients who received HDAA infusion during acute burn resuscitation.

Methods: This study is an IRB approved retrospective chart review of all adult burn patients admitted from January 2016 through December 2018 who received HDAA for resuscitation. Patients were excluded if age < 18 years, had pre-existing hemodialysis-dependent chronic kidney disease, received < 16 hours of HDAA, or expired/withdrew from care within 48 hours of admission. The primary outcome was the incidence of patients receiving HDAA infusion who required renal replacement therapy (RRT) within 7 days of admission. Secondary outcomes included the incidence of intra-abdominal hypertension, duration of mechanical ventilation, actual crystalloid volume administered in the first 24 hours compared to estimated volume, ICU length of stay (LOS), and mortality.

Results: Twenty-four patients were included with a median age of 47.5 (32-58) and a median TBSA of 45.8 (36.3-56.4). The estimated fluid requirements in the 1st 24 hours were calculated using 4mL/kg/TBSA. Four patients required RRT (16.7%) and 12 patients were diagnosed with intrabdominal hypertension (50%). The median volume of crystalloid administered in the 1st 24 hours was 5.5 mL/kg/TBSA (4.7-7.2), and the ratio of actual to estimated crystalloid in the 1st 24 hours was 1.37 (0.73 – 2.64). Seventeen patients received albumin therapy in the 1st 24 hours. The median urine output in 1st 24 hours was 1.4 mL/kg/hr (1.2 – 2.0). Median duration of mechanical ventilation and ICU LOS was 9 (4-21) and 9.5 (2-57) days respectively. Thirteen patients died (54.2%).

Conclusions: The incidence of patients requiring RRT, along with the crystalloid volume administered and the observed to expected ratio of crystalloids in the 1st 24 hours were comparable to recent literature. The known effect of osmotic diuresis from HDAA potentially impacted fluid titration practice, increasing the risk of complications from overresuscitation such as intrabdominal hypertension, and mortality. Additionally, the estimation of 24-hour fluid requirements using the Parkland Formula versus the Modified Brooke Formula may have contributed to the rates of intraabdominal hypertension. Further studies comparing fluid management strategies are necessary.

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Posted in: Burn Medicine101