Assessment of vitamin and trace elementsupplementation in severely burned patients undergoing long-term parenteral and enteral nutrition

The efficacy of an oral supplement of vitamins and trace elements during a long-termartificial parenteral and enteral nutrition was investigated for 3 months in patients with extensive burns. Thirty severely burned patients (22 male, 8 female, age 41 ± 18 years, range 23–59 years, 33 ± 12% total body surface area burn, 22% ± 8 full thickness burn surface area) were included. Every 10 days, from day 10 until day 90, we determined serum levels of: • vitamins B1, B12, A, E • folic acid • copper, zinc, iron • transferrin, albumin, prealbumin, total proteins • fibronectin, retinol binding protein (RBP) • calcium • phosphorus • triglycerides • total cholesterol • C reactive protein (CRP) • erythrocyte folic acid The mean daily nutritional support was 60 Kcals and 0.4 g N per kg of body weight, 70% enterally and 30% parenterally administered, with enteral vitamin and trace element supplementation. On day 10, there was a decrease of the serum level of 19/20 parameters. For 8 parameters (vitamin A, total cholesterol, iron, transferrin, fibronectin, phosphorus, RBP, total proteins), the level was lower than usual. Between day 10 and day 20, a significant normalization of 6 of them was noted, the average levels of transferrin and iron remaining below normal values until day 50. There was a significant decrease in C-reactive protein levels, however above normal limits. No deficiency in vitamins or trace elements was found. Cyclic variations of serum levels occurred which may be more related to volemic, hydroelectrolytic, endocrine and inflammatory disorders than to nutritional problems.