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THE
BURN NUTRITION MODULE
PART
X
Metabolic
Response to Burn Injury During Recovery Phase
'Stress Resolving With Nutritional Support'
Having
discussed the increased needs for energy in the recovery period we
can focus on the nutritional support required during this period. A
composite schema is presented.
The
metabolic characteristics are:
1)
a more normal nutrient utilization
2) decreased stimulus to gluconeogenesis unless nutrient demands
are not met
3) increased energy demands required for increased protein
synthesis and for increased activity
4) increased protein demands to restore lean mass |
During
the recovery phase when the stress response is resolving, restoration of
lean mass occurs. However, the rate of restoration is 5-10 times
slower than the rate of loss. The anabolic activity provided by
hormones remains low and never really compensates for the high catabolic
rate with stress. Because weight and lean mass restoration is
energy and protein requiring, increased macronutrient intake
persists. Of interest is the fact that increasing anabolic
activity by providing exogeneous anabolic hormones as well as the
anabolic stimulus of exercise, will markedly increase the rate of lean
mass restoration.
The
kilocalorie demands are 25-50% above normal with the more normal
distribution of carbohydrates, fat and protein. Protein intake needs
to remain about two times the RDA (1.5 - 2 g/kg/day) to meet
increased demands. Added anabolic stimuli will further increase the
rate of protein synthesis. This rate of normalization is due to a
more normal hormone balance. Remember that any remaining wounds or
inflammation will produce a catabolic stimulus.
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