ascorbic-acid and Compartment-Syndromes

Compartment syndrome is a unique form of ischaemia of skeletal muscle which occurs despite patency of the large vessels. Decompression allows the influx of activated leucocytes which cause further injury. Vitamin C is a powerful antioxidant which concentrates preferentially in leucocytes and attenuates reperfusion-induced muscle injury. We have evaluated the use of pretreatment with oral vitamin C in the prevention of injury caused by compartment syndrome in a rat cremasteric muscle model. Acute and delayed effects of pretreatment with vitamin C were assessed at one and 24 hours after decompression of compartment syndrome. Muscle function was assessed electrophysiologically. Vascular, cellular and tissue inflammation was assessed by staining of intercellular adhesion molecule-1 (ICAM-1) and by determination of the activity of myeloperoxidase (MPO) in neutrophils and tissue oedema. Compartment syndrome impaired skeletal muscle function and increased the expression of ICAM-1, activity of MPO and muscle weight increased significantly. Pretreatment with vitamin C preserved muscle function and reduced the expression of ICAM-1, infiltration of the neutrophils and oedema.

Topics: Administration, Oral; Animals; Ascorbic Acid; Compartment Syndromes; Edema; Intercellular Adhesion Molecule-1; Muscle, Skeletal; Peroxidase; Rats; Rats, Sprague-Dawley; Reperfusion Injury

Old people living alone and in poverty are most at risk for developing scurvy, but the diagnosis may be missed unless the physician is aware of it. A 42-year-old immigrant living in poverty was treated surgically at the Hôtel-Dieu Hospital in Montreal for a compartment syndrome of the leg. She had ecchymoses on the skin of the leg and an interstitial hematoma in both posterior compartments. Three weeks later, she was readmitted with more swelling in the leg, gingivitis, hemorrhagic folliculitis, petechiae and gastrointestinal hemorrhage. Her response to vitamin C was remarkable and confirmed the diagnosis of scurvy.

Topics: Adult; Ascorbic Acid; Compartment Syndromes; Feeding Behavior; Female; Humans; Leg; Poverty; Scurvy