OBJECTIVETo investigate the effects and the mechanism of action of postburn dietary supplementation of levorotatory arginine (L-Arg) on burn shock resuscitation in severely burned patients.

METHODSThis study was designed to be a prospective, randomized, single blinded and controlled one. Twenty burn patients with total burn surface area (TBSA) more than 30% were enrolled and randomized into two groups; 1) Group A (n = 10): enteral feeding of 50 g/L glucose normal saline (GNS) 500 ml per day containing L-Arg (400 mg/kg.day) at equal pace with fluid infusion for shock resuscitation for 4 days. 2) Group C (n = 10): enteral feeding with only 50 g/L GNS 500 ml per day for 4 days. All of the twenty patients received equal amount of enteral feeding via an intra-gastric tube with the aid of an enteral feeding pump, started within 24 postburn hours (PBH). Venous blood was harvested from all the patients in both groups on 1, 2, 3 and 4 postburn day (PBD) for the determination of serum content of nitric oxide (NO), malondialdehyde (MDA) and the activity of serum superoxide dismutase (SOD). And the arterial content of lactate (BL) was also determined concomitantly.

RESULTSThe results indicated that the serum SOD activity in group A was increased after burns, peaked on 4 PBD (68 +/- 23 U/ml), and it was obviously higher than that in group C (31 +/- 9 U/ml, P < 0.01). The serum contents of MDA and NO were decreased in both groups after burns. On 2 PBD, the serum NO level in group A decreased to the lowest level (50 +/- 14 micromol/L), which was obviously lower compared with group C (78 +/- 22 micromol/L, P < 0.01). On 4 PBD, serum MDA levels in group A (3.4 +/- 0.8 micromol/L) and group C (3.5 +/- 1.3 micromol/L) were decreased to the lowest level. The BL content in group A was obviously lower than that in group C on 2 and 3 PBD (P < 0.05 or 0.01).

CONCLUSIONEnteral supplementation of L-arginine can decrease excessive NO production to a relatively normal level, and it might be beneficial to resuscitation of burn shock. It might also exert a protective effect against ischemia/reperfusion injury to burn patients.