Annals of Burns and Fire Disasters - vol. XII - n° 3 - September 1999EXAMINATION OF SERUM ZINC, COPPER, MAGNESIUM, AND IRON LEVELS IN PATIENTS WITH ELECTRIC AND FLAME/SCALD BURNS
Gümüs N., Safran Z.B., Acarturk S., Abdülrezzak A.
Burn Unit of Plastic and Reconstructive Surgery Department, Faculty of Medicine, Qukurova University, Adana, Turkey
SUMMARY. In this study, 5 cc venous blood samples were taken on the Ist, 4th, 8th, 13th, and 20th days post-burn from 17 patients with high-tension electric burns, 14 with flame burns, and one with scald burns. Scrum zinc, copper, magnesium, and iron levels were determined using an atomic absorption spectrophotometer. Venous blood samples were taken from 20 healthy volunteers as control levels for these elements. The results were evaluated using the Mann-Whitney U test. On each day the serum levels of the elements were found to be significantly lower than those of the control group (p < 0.05). The element levels in the electric burn patients were also markedly lower than those in the healthy group (p < 0.05). A comparison of the element levels in the flame and scald burn patients with those of the electric burn patients by means of the Mann-Whitney U test did not reveal any differences (p > 0.05).
Trace elements are inorganic
substances found in human blood in the order of micrograms. These elements are
incorporated into the structures of proteins, enzymes, and complex carbohydrates. They
take part in biochemical reactions together with enzymes. Zinc (Zn) and copper (Cu) are
especially active in metabolic and biochemical processes in the recovery phase of wounds.
It is known that the trace elements are necessary for the continuous systematic
functioning of the immune system." Magnesium (Mg) is required for the synthesis of
all proteins, nucleic acids, nueleotides, lipids, and carbohydrates, as also for the
contraction of muscles. Iron (Fe), apart from its presence in all body cells, plays a role
in the oxygenation of tissues as it is incorporated in the haeme structure of haemoglobin.
Materials and methods
The study was conducted prospectively
between January 1996 and September 1998 at the Burn Unit of the Cukurova University,
Department of Plastic and Reconstructive Surgery Faculty of Medicine. Seventeen
high-tension electrically burned patients, 14 with flame burns, and one with scald burns
were included in the study. Serum trace element levels obtained from 20 healthy adults
were used as controls. All the patients but one were male. The average age of the
electrically burned patients was 25.1 ± 13.3 yr and that of the flame and scald burned
patients 34.2 ± 13.0 yr. In the control group the average age was 33.8 ± 12.6 yr. The
average burned body surface area was 20.9 ± 11.2% in the electrically burned patients and
36.1 ± 16.6% in the flame and scald burn patients. Patients who reported to our emergency
service in the first 24 It after the burn were admitted to our burn unit. In all patients
an intravenous way was accessed and fluid treatment was initiated based on the Parkland
fonnula. A urinary catheter was put in place and the hourly urine output was monitored.
The patients' vital signs, urinary output, and haematuria were also monitored and
appropriate fluid was added accordingly. In the high-tension electrical burn patients
fasciotomy was performed when the development of compartment syndrome in the limb was
considered likely, in order to free the extremity. Routine wound care and dressings were
applied in the treatment of the burn wounds.
The average trace element values of the patients with flame and scald burns were determined 1, 4, 8, 13, and 20 days post-burn. The average Mg levels were respectively 18.6 ± 2.1, 18.5 ± 1.9, 19.0 ± 2.1, 17.7 ± 1.4, and 18.3 ± 1.2 mg/dl (Fig. 1). The average Zn levels for the respective sampling days were 69.6 ± 11.7, 75 .0 ± 23.3, 65.0 ± 12.8, 74.2 ± 25.6, and 71.0 ± 17.8 ~g/dl (Fig. 2).
The average Cu levels for the respective days were 83.7 ±15.6, 86.3 ± 19.9, 91.0 ± 15.9, 96.7 ± 15.2, and 96.6 ± 16.9µg/dl (Fig. 3). The levels for Fe were 34.0 ± 24.2, 38.6 ± 22.6, 32.7 ± 19.6, 40.0 ± 30.7, and 47.3 ± 21.4 µg/dl respectively (Fig. 4).
The trace element levels
for the electrically burned patients on the Ist, 4th, 8th, 13th, and 20th days were as
follows: average Mg levels, 17.2 ± 2.2, 17.4 ± 2.7, 17.4 + 2.7, 17.0 ± 2.5, and
17.6 ± 2.8 mg/dl respectively; average Zn levels, 77.17 ± 24.5, 78.1 ± 29.6, 75.3 ±
24.5, 80.2 ± 37.0, and 76.5 ± 32.0 µg/dl respectively; average Cu levels, 80.8 12.9,
82.8 ± 15.4, 88.0 ± 27.4, 84.6 ± 20.3, and 90.0 20.3 µg/dl respectively (Figs.
1-3). The Fe levels for the respective days were 32.6 ± 19.4, 28.0 21.6, 31.4 ±
18.5, 41.0 ± 16.9, and 40.7 ± 19.0 g/dl (Fig. 4).
The average percentage of the burned
body area in our electric burn patients was 20.9 ± 11.2%, compared with 36.1 ± 16.6% of
the flame and scald burn patients. The percentage burn of our electric burn patients was
markedly lower than the burn area in the flame and scald burn patients. Necrosis could be
seen in the subcutaneous tissue, muscles, nerves, vessels, and bone tissues. For this
reason, although the percentage burn was low in high-tension electric burns the damage was
serious and deep. Despite the fact that these patients reported to our clinic on the
first, day of their burns and fasciotomy was performed, in some patients necrosis of the
limb could not be prevented. In electrical burns of the limbs, from the early stage
necrotic tissue was removed by serial debridement. However, in 35.3% of the patients
amputation of the limb was still inevitable. In a study by Achauer et al. in which 22
patients with electric burns of the upper limbs were examined, it was shown that 40% of
the cases required amputation. This was a retrospective study covering 10 years.
RESUME. Cette étude considère 32 patients brûlés, dont 17 par electricité à haute tension, 14 par flammes et un par ébouillantement. Des prélèvements de sang veineux (5 cc) ont été effectués le premier, 4ème, 8ème, 13ème et 20ème jour après la brûlure. Les niveaux de zinc, cuivre, magnésium et fer sérique ont été detenninés avec l'emploi d'un spectrophotomètre d'absorption atomique. Des prélèvements de sang veineux obtenus dans 20 volontaires sains ont été utilisés comme valeurs témoins. Les résultats ont été évalués avec le test U de Mann-Whitney. Les Auteurs ont trouvé que les niveaux sériques des éléments, tous les jours, étaient significativement inférieurs aux valeurs présentées par le groupe témoin (p < 0,05). Aussi les niveaux des éléments dans les patients atteints de brûlures électriques étaient notamment inférieurs aux valeurs du groupe sain (p < 0,05). La comparaison entre les niveaux des éléments dans les patients atteints de brûlures par flamme et par ébouillantement et ceux des patients atteints de brûlures électriques, effectuée en utilisant le test U de Mann-Whitney, n'a révélé aucune différence W < 0,05).