Two cases of major burn complicated with acute renal failure which may have been precipitated by vitamin C administration

• Published in: Nihon Kyukyu Igakukai Zasshi Vol. 23; no. 5; pp. 199 - 204
• Main Authors: Nagano, Osamu, Tada, Keitaro, Shiba, Naoki, Hirayama, Takahiro, Kuroda, Hiromitsu, Terado, Michihisa, Ujike, Yoshihito
• Format: Journal Article
• Language: Japanese
• Published: Japanese Association for Acute Medicine 15.05.2012
• Subjects: acute renal failure; ascorbic acid; oxalate
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.23.199

We report two cases of major burn complicated with acute renal failure which may have been precipitated by vitamin C (VC) administration. Case 1 was a 70 years old male with total burn surface area (TBSA) 45% and burn index (BI) 41. In the acute phase, VC (2.5-4g/day) was administered and renal function deteriorated. On day 4, VC administration was stopped and continuous hemodiafiltration (CHDF) started. Renal function recovered after day 21. Case 2 was a 68 years old male with TBSA 63% and BI 41. In the acute phase, renal function was maintained despite a massive dose of VC (VC 25g/initial 24 hours). However, on day 9 VC supplementation (0.6-1.2g/day) was started and then renal function deteriorated rapidly. His renal function did not recover despite continuing blood purification, perhaps related to continuing VC. Although VC administration has been thought to be safe, it has been reported that VC may cause renal dysfunction due to accumulation of its metabolite oxalate. In case 1, oxalosis was suspected because of high oxalate level in the waste fluid of CHDF. These cases suggest that VC administration should be stopped and aggressive blood purification should be performed when renal dysfunction worsens during VC administration.