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The
Metabolic Response to Burn Injury and The Role Of Nutritional
Support
AUTHORS:
Robert
H. Demling, M.D. Leslie
DeSanti R.N.,
Dennis P. Orgill, M.D. Ph.D.
The
logical approach to understanding the complex metabolic
derangements produced by a burn, is to link the disorder with
a nutritional treatment. Since the goals of nutrition are
directly linked with the metabolic changes, two complex topics
become more simplified when linked together.
The
best way to understand this extremely important topic is to
break the metabolic problem and the nutritional support into
its fundamental concepts then build on the basics.
There
are two basic metabolic abnormalities produced by any burn. First
there is a marked and persistent increase in energy demands by
the burn patient initiated by the burn injury and the body’s
‘response’ to the injury. This constant high energy demand
is comparable to jogging on a treadmill continuously for weeks
to months, the pace increasing with burn size and other
stressors.
The
nutritional goal is to define the energy needs, then
delivery the appropriate quantity and mix of nutrients to meet
the energy demands.
The
second abnormality is a destructive body catabolism
which means a rapid and persistent breakdown of body protein.
Since protein makes up the metabolic machinery and body
structure, most prominently muscle, loss of protein is
deleterious.
The
nutritional goal is to provide the required protein
intake, and stimulus for protein synthesis, in order to meet
the increased demands for tissue synthesis and repair.
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