Wound Management
Depends on the depth and extent of burns. Current surgical management promotes early debridment, excision and grafting.Wound healing can occur only in an anabolic state. Feeding should be initiated soon after resuscitation.
Nutrition Therapy
Early enteral feedings (within 4-12hrs of hospitalization) has been shown to be successful in
• Decreasing hypercatabolic response
• Decreasing release of catecholamines
• Decreasing glucagon
• Reducing weight loss &
• Shortening the length of stay
(McClave SA etal: Enteral access for nutrition support: rationale for utilization, J. Clin. Gastroenterol.35:209, 2002)
Energy Requirements
Increased energy needs of a burned patient vary according to the size of the burn
Curreri Formula
Energy = 24kcal x usual body wt (kg) + 40kcal x %TBSA burned
Ireton-Jones Formula
Energy = 1784 – 11(A) + 5(W) + 244(S) + 239(T) + 804(B)
A-age in years W-weight in kg
S – sex (male-1, female-0) T- trauma (absent-0, present-1) B- Burns (absent-0, present-1)
Energy Sources
• Carbohydrates are excellent for protein sparing
• Maximum glucose: 5-7mg/kg/min
• Excessive CHOs can aggravate hyperglycemia and cause
- Osmotic diuresis
- Dehydration
- Respiratory difficulty
Energy Sources
• Lipids are concentrated sources of calories
• Limit lipids to 12-15% of the non-protein calories
• High levels may cause deleterious immunologic responses and increase susceptibility to infections
Proteins
• Protein needs are elevated due to losses through urine and wounds, increased use of
gluconeogenesis and wound healing
• 20-25% of total calories as proteins
• Proteins with high biological value are suggested1
1. Mayes T, Gottschlich MM: Burns and wound healing. Contemporary nutrition support practice: a clinical guide, ed2, Philadelphia, 2003, WB Saunders
• BCAAs have no beneficial effect in burn patients1
• Conditionally essential amino acids such as glutamine improves immunity and wound healing2
• Blood urea, S. creatinine and hydration must be monitored for all patients on high protein diets
1. Alexander JW, Gottschlich MM: Nutrition immunomodulation in burn patients, Crit Care Med 18:S149,1990
2. Peng X et al: Analysis of efficacy and safety of glutamine granules in severely burned patients, Annals of Burns and Fire Disasters - vol. XVII - n. 2 - June 2004
Vitamins & Minerals
Vitamin needs increase in burns patients
Vit C is involved in collagen synthesis and immune function
- Doses of 500mg twice daily are the routine protocol at some burn centers1
Vit A is also an important nutrient for immune function and epithelialization.
- Dosage: 5000IU per 1000 calories of EN1
1. Mayes T, Gottschlich MM: Burns and wound healing. Contemporary nutrition support practice: a clinical guide, ed2, Philadelphia, 2003, WB Saunders
• Electrolyte imbalances involving sodium and potassium are usually corrected by adjusting fluid therapy.
• Depression of calcium levels seen in patients with >30% of TBSA.
• Hypophosphatemia is also identified in patients with major burns. This is mostly due to large
volumes of resuscitation fluid along with parenteral infusion of glucose.
• Magnesium levels also need to be closely monitored due to losses from burn wounds
• IV magnesium is given to prevent GI irritation
• Zinc is a cofactor in energy metabolism and protein synthesis.
- Dosage: 220mg zinc sulfate1
1. Mayes T, Gottschlich MM: Burns and wound healing. Contemporary nutrition support practice: a clinical guide, ed2, Philadelphia, 2003, WB Saunders
Methods of Nutrition Support
• Most patients with <20% TBSA are able to meet their requirement with regular high calorie-
high protein diet
• Commercial nutrition supplements may be necessary to meet the high calorie-protein
requirements.
• Oral glutamine supplementation in conjunction with routine nutrition support is shown to blunt
stress response, improve N balance and immunity.
• Enteral feeding is a preferred method of nutrition support but PN may be necessary with early
excision and grafting to avoid frequent interruptions in EN.
• TPN is the choice for
- Patients with persistent ileus who do not tolerate tube feeding or
- who have high risk of aspiration
