Ovid: Bonham: Br J Surg, Volume 86(10).October 1999.1296-1301 http://gateway.ut.ovid.com.ezproxy.lib.monash.edu.au/gw1/ovidweb.cgi 1 of 7 19/01/2006 2:13 PM © 1999 Blackwell Science Ltd. Volume 86(10), October 1999, pp 1296-1301 Early ascorbic acid depletion is related to the severity of acute pancreatitis [Original Article] Bonham, M. J. D.; Abu-Zidan, F. M.; Simovic, M. O.; Sluis, K. B.*; Wilkinson, A.*; Winterbourn, C. C.*; Windsor, J. A. Pancreatitis Research Group, Department of Surgery, Faculty of Medicine and Health Science, University of Auckland, Auckland and *Department of Pathology, Christchurch School of Medicine, Christchurch, New Zealand Correspondence to: Mr J. A. Windsor, Department of Surgery, Auckland Hospital, Faculty of Medicine and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand Presented to a meeting of the Australasian Surgical Research Society, Auckland, New Zealand, August 1995 and published in abstract form as Aust N Z J Surg 1996; 66: 243 Paper accepted 31 March 1999 Abstract Background: Ascorbic acid (AA) is an important endogenous antioxidant in plasma and has been shown to be decreased at the time of hospital admission in patients with acute pancreatitis. The aim of this study was to determine whether plasma AA concentration continues to decrease after admission and whether the extent of decrease is related to the severity of pancreatitis. Methods: Consecutive patients with mild (n = 62) and severe (n = 23) acute pancreatitis had plasma AA concentration measured on the day of recruitment and on days 2 and 5 by high-performance liquid chromatography. Results: The plasma AA concentration in patients with acute pancreatitis was significantly less than that in normal volunteers on days 0, 2 and 5 (P < 0.0001) and this was more marked in those with severe disease. There was a decrease in plasma AA concentration from day 0 to day 2 in patients with mild (P < 0.0001) and severe (P = 0.0005) pancreatitis, and from day 2 to day 5 in patients with severe pancreatitis (P = 0.023). Conclusion: Endogenous plasma AA continues to decrease over the first 5 days in hospital and the extent is related to the severity of acute pancreatitis. Introduction The management of acute pancreatitis is difficult because the key steps in its pathogenesis are not well understood. Experimental 1-4 and clinical 5,6 studies have provided some support for the concept that oxidative stress is the common pathway for the initiation of acute pancreatitis. Oxidative stress occurs when there is an imbalance between prooxidant activity and endogenous antioxidant defences. The most abundant endogenous antioxidant in the aqueous phase is ascorbic acid (AA) which is the bioactive form of vitamin C. Two studies of acute pancreatitis demonstrated that plasma AA was significantly below normal by the time patients were admitted to hospital, and that this fall was greater in acute pancreatitis than in other causes of acute abdomen 5,7. This study was undertaken to determine whether plasma AA concentration continues to decrease after admission and whether the extent of decrease is related to the severity of pancreatitis.