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Antioxidant / Capillary integrity support Pregnancy: Safe at normal doses. High-dose IV: use only if clearly indicated.

Ascorbic Acid (Vitamin C — High-dose Burns)

Brand names: Pabrinex IV (high-potency vitamins), Vitamin C injection

Adult dose

Dose: Major burns resuscitation: 66 mg/kg/hour IV for 24 hours (Tanaka protocol)
Route: IV infusion
Frequency: Continuous 24-hour infusion starting as early as possible
Max: 66 mg/kg/hour for 24 hours (Tanaka protocol); up to 3 g/day oral for general supplementation
Major burns (>20% TBSA): Tanaka protocol — 66 mg/kg/hour IV Vitamin C for 24 hours from time of burn. Reduces capillary leak, fluid requirements, and oedema. Standard oral supplementation: 250–1000 mg/day. Oral/IV Vitamin C and thiamine given alongside burns resuscitation in many centres.

Paediatric dose

Dose: 66 mg/kg
Route: IV
Frequency: Continuous over 24 hours
Max: 66 mg/kg/hour for 24 hours
Concentration: 100 mg/ml
Paediatric major burns: same Tanaka protocol — 66 mg/kg/hour IV Vitamin C for 24 hours. Calculate dose based on actual body weight.

Dose adjustments

Renal

Use with caution in renal impairment — oxalate nephropathy risk with high doses.

Hepatic

No specific adjustment.

Paediatric weight-based calculator

Paediatric major burns: same Tanaka protocol — 66 mg/kg/hour IV Vitamin C for 24 hours. Calculate dose based on actual body weight.

Clinical pearls

  • Tanaka 2000 RCT: 66 mg/kg/hour IV Vit C for 24h reduced fluid requirements by 40% in major burns
  • Reduces capillary leak by scavenging reactive oxygen species (antioxidant)
  • Monitor renal function and urine output — risk of oxalate deposits
  • Used alongside standard Parkland formula or modified resuscitation protocols
  • Some burns centres add Vit C to all Parkland resuscitation fluid

Contraindications

  • G6PD deficiency (haemolysis with high-dose IV Vitamin C)
  • Oxalate nephrolithiasis history (high-dose)

Side effects

  • Oxalate nephropathy (high-dose IV)
  • Osmotic diarrhoea (high-dose oral)
  • Thrombophlebitis at IV site (use large vein)
  • Nausea

Interactions

  • Warfarin — high-dose Vitamin C may reduce INR (unpredictable)
  • Deferoxamine — increased tissue iron toxicity with IV Vitamin C

Monitoring

  • Fluid balance and urine output
  • Renal function
  • Electrolytes

Reference: BNFc; BNF; Tanaka H, et al. Archives of Surgery 2000; ABA Burns Resuscitation Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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