Is Giving Vitamins A and C, Arginine and Zinc to All Stage IV Pressure Ulcer Patients Justified?

The management of patients with stage IV pressure ulcers entails the administration of vitamin A, vitamin C, zinc, and arginine without checking their levels. However, no evidence-based studies to suggest the true benefit of this standard exist. Many such patients are otherwise well-nourished and consume adequate amounts of these nutrients in their diets. Supplementing these vitamins and amino acids as part of a standard wound care protocol may risk toxicity and unnecessarily increase the cost of healthcare. We aimed to prove that patients with chronic pressure ulcers may be over treated due to the assumption that they are deficient in vitamins A and C, zinc, and arginine without actually checking their plasma levels. This study also aims to correlate the nutrition status represented by albumin and pre-albumin levels with aforementioned vitamin and amino acid levels. This would determine whether albumin and pre-albumin levels have good predictive value of the vitamin levels.

Twenty patients, aged 18-90, were included in this study. Patients were admitted to the acute hospital setting with unstageable pressure ulcers or stage IV pressure ulcers on their sacrum, hips, or heels. Patients already on vitamins A or C, zinc, or arginine supplements were excluded from the study. On arrival, blood levels of vitamins A and C, zinc, and arginine were obtained. Albumin and pre-albumin levels were also obtained. Nutrition status of each patient was determined to be good, acceptable, or poor based on specific cutoffs of albumin and pre-albumin levels. Patients were de-identified and data was stored in a secure file accessible only to study staff.  

Results and correlation between nutrition status (based on albumin and pre-albumin) and vitamins A and C, arginine and zinc levels will be presented and discussed.

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