Micronutrient Homeostasis

Burn injury is marked by a reduction in plasma concentration of most vitamins and trace elements, many of which play a major role as antioxidants. Following severe injury, the body is subject to substantial oxidative stress (direct lipid oxidation, inflammation, sepsis) as well as to endogenous endocrine changes generated by the stress response. Deficiencies in zinc and copper occur as a result of exudative loss in the burn wound and urinary wasting. The pathophysiology of deficiencies of ascorbic acid and vitamin E is less clear. Vitamin D becomes progressively deficient due to failure of skin to produce normal quantities. Other micronutrients for which deficiencies are reported serve as acute-phase reactants following systemic inflammation. Thus copper, zinc, iron, and chromium, among others, are subject to a greater demand for utilization. Antioxidant supplementation appears to have beneficial effects on morbidity and mortality; nutritional requirements are increased above RDA in the acute post-burn state, and precise antioxidant requirements have yet to be determined.