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THE BURN NUTRITION MODULE

Robert H. Demling, M.D. Leslie DeSanti R.N., Dennis P. Orgill, M.D. PhD.

Section XI

What is the importance of providing adequate hydration with nutrition?

Maintain adequate intracellular volume required for cell metabolism

Maintain adequate extra cellular volume needed for

transport of O₂ and nutrients to the cell
transport of urea and byproducts away from the cell
adequate clearance of these by products by the kidney

Having discussed optimum nutrient and micronutrient support, it is now essential that the importance of maintaining hydration be addressed. Inadequate hydration will impede nutritional support by impairing intracellular metabolism as cell volume decreases.

In addition on adequate extra cellular volume is required for transport of oxygen and nutrients to the cell and metabolites away from the cell.

In addition metabolites must be excreted which requires adequate renal clearance. Dehydration impedes renal function.

The Problem Of Post Burn Water Loss

Loss of skin integrity produces a massive loss of water from the wound surface (till wound closure)

Hyper metabolism increases urinary output (water losses) 2 to 3 fold above normal

Gastrointestinal losses can be severe with presence of diarrhea

What Are The Fluid (Water) Losses After Burn?

STATUS OF BODILY FLUID WATER BALANCE

ADEQUATE	INADEQUATE	EXCESS
Urine spec gravity 1.010 - 1.020 normosmolar state good turgor non burned skin	Urine spec gravity > 1.020 hyperosmolar hypernatremia pre-renal azotemia	Urine Spec gravity < 1.010 hypo-osmolar hypernatremia