Nitric oxide production in burns: Plasma nitrate levels are not increased in patients with minor thermal injuries

Background: Recent studies have suggested that adults who sustain burns of less than 15% total body surface area display elevated plasma nitrate levels, indicating increased production of nitric oxide, The present study was initiated to confirm whether plasma nitrate is elevated in minor burn injury and, if so, whether it heralds the onset of a systemic inflammatory response to that injury. Methods: Plasma samples were taken from 98 control and 10 burns patients. Results: The mean plasma nitrate level for nine burns patients with a mean total body surface area burnt of 7.65% (range, 4-15%) was 42.83 mu mol/L on day 1. This was not significantly different from that of a control population of 98 preoperative plastic surgery patients: 36.91 mu mol/L (p = 0.162), Eight of 10 burns patients showed a decrease in plasma nitrate to 27.47 mu mol/L by day 3 (p = 0.046), Elevated nitrate levels were seen in 2 of 10 burns patients, One had concurrent smoke-inhalation injury preceding multiple organ dysfunction, and one was treated with a cream containing cerium nitrate (Flammacerium, Duphar Laboratories, Southhampton, United Kingdom). Conclusions: For patients who sustain minor burns, plasma levels of nitrate decrease from those of mean normal controls with time unless there is multiple organ dysfunction or the patient receives extraneous nitrate.