Trace element repletion following severe burn injury: A dose-finding cohort study.

Pantet, Olivier; Stoecklin, Patricia; Charrière, Mélanie; Voirol, Pierre; Vernay, Arnaud; Berger, Mette M (2019). Trace element repletion following severe burn injury: A dose-finding cohort study. Clinical nutrition, 38(1), pp. 246-251. Elsevier 10.1016/j.clnu.2018.01.025

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BACKGROUND & AIMS Major burn patients are characterized by large exudative losses of Cu, Se and Zn. Trace element (TE) repletion has been shown to improve clinical outcome. Having increased the TE doses over time, the study aimed at analysing if our repletion protocol corrected TE plasma concentrations and if the necessity for continuous renal replacement therapy (CRRT) might increase the TE needs. METHODS Retrospective analysis of prospectively collected data in burn patients requiring intensive care (ICU) between 1999 and 2015. INCLUSION CRITERIA Admission on day 1, full treatment, burned surface area (TBSA) ≥20% and ≥1 TE plasma determination during the stay. Four groups were constituted according to protocol changes. Period 1 (P1): 1999-2000, P2: 2001-2005, P3: 2006-2010, P4: 2011-2015. Changes consisted in increasing TE repletion doses and duration. Demographic data, daily TE intakes and weekly plasma concentrations were retrieved for the first 21 ICU-days. Data as median (IQR). RESULTS 139 patients completed the criteria, aged 37 (28) years, burned on 35 (25) % TBSA. As a result of prescription, Cu, Se and Zn intakes increased significantly between P1 and P4, resulting in normalization of plasma Cu (16 μmol/l) since P3 and Zn (13.5 μmol/l) since P2. Median plasma Se were above reference range (1400 nmol/l) during P3 and P4. CRRT patients required higher doses of Cu for maintenance within normal ranges. CONCLUSION This dose finding study shows that the latest repletion protocol is safe and normalizes Cu and Zn concentrations. Se doses result in supra-normal Se concentrations, suggesting prescription reduction. CRRT patients are at high risk of Cu depletion and require specific monitoring.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Stoecklin, Patricia Gabrielle

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0261-5614

Publisher:

Elsevier

Language:

English

Submitter:

Jsabelle Arni

Date Deposited:

05 Dec 2019 12:48

Last Modified:

05 Dec 2019 12:48

Publisher DOI:

10.1016/j.clnu.2018.01.025

PubMed ID:

29428787

Uncontrolled Keywords:

Burn Copper Critical care Renal replacement therapy Selenium Zinc

BORIS DOI:

10.7892/boris.136168

URI:

https://boris.unibe.ch/id/eprint/136168

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