1. Trace element intakes should be revisited in burn nutrition protocols: A cohort study
- Author
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Wassim Raffoul, Mette M. Berger, Daniel Haselbach, William Watfa, Lee Ann Applegate, Olivier Pantet, Marc Augsburger, Aurélien Thomas, Paris Jafari, and Murielle Michetti
- Subjects
Adult ,Male ,0301 basic medicine ,Burn injury ,medicine.medical_specialty ,Nutritional Status ,Reference range ,Critical Care and Intensive Care Medicine ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Animal science ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Inductively coupled plasma mass spectrometry ,Aged ,Aged, 80 and over ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Spectrophotometry, Atomic ,Nutritional Requirements ,Trace element ,030208 emergency & critical care medicine ,Middle Aged ,Micronutrient ,Trace Elements ,Surgery ,Parenteral nutrition ,Dietary Supplements ,Female ,Burns ,business ,Total body surface area - Abstract
Due to inflammatory and hypermetabolic responses and to extensive exudative trace element (TEs) losses, major burn patients have substantially increased nutritional requirements. To date, information is only available for Cu, Se, and Zn. We aimed at analyzing losses of 12 TEs and Mg through burn wound exudation and corresponding plasma concentrations during the first week after burn injury, and to evaluate the impact of current TE repletion protocols.Burn wound exudate was collected under negative pressure in 15 adult patients burned 29 ± 20% of body surface (TBSA) for 8 days after injury. Two samples were collected daily. The TE concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS). Losses and serum concentrations were compared to intakes.For the majority of 12 TEs, the highest losses were observed on day 1, and declined thereafter. Despite Cu supplementation (4.23 mg/day) serum levels remained below reference values. Se supplements (745 μg/day) normalized and even increased serum levels to upper normal value. Despite large supplements (Zn 67.5 mg/day), serum Zn values remained below reference range. Large exudative losses of B, Br and Mg were found, as well as of Fe and I, with the latter being probably due to contamination.Current nutritional Cu, Se, Zn repletion protocols in major burn patients which were based on measured exudative losses should be revised to include higher Cu and lower Se doses, as well as planned Mg administration. In burns20% TBSA and for the other TEs the recommended parenteral nutrition TE doses appear sufficient.
- Published
- 2018