Burn patient malnutrition

One of the characteristics of critical illness is hypermetabolism. Trauma, burn injury, and sepsis are aU catalysts for the release of mediators that initiate and regulate the hypermetabohc response. The metabolic consequences of this response include altered carbohydrate metabolism, increased protein synthesis and degradation, and increased lipid oxidation, which ultimately result in loss of protein and lean body mass." In a previously well-nourished individual, critical illness can result in the onset of kwashiorkor-like malnutrition within 5 to 7 days. In a previously malnourished individual, critical illness can precipitate severe mixed marasmus-kwashiorkor in 3 to 5 days. In a prospective study of 129 patients admitted to the intensive care unit (ICU), 43% were malnourished." The malnourished patients had an increased length of stay in the ICU (a mean of 27 vs. 19 days) and a statistically significantly increased incidence of complications (55% vs. 40%) compared with well-nourished patients with a similar severity of illness. 

Other circumstances predispose to significant malnutrition in subjects of any age. Severe trauma, burns, or sepsis are hypermetabolic states requiring massive nutritional support such as hyperalimentation. Nutrition in acutely and chronically ill patients is often inadequate. Even in an informed, affluent society, some people, such as alcoholics, are inadequately nourished because of overconsumption of foods of low nutritional value. For example, wet beriberi has reappeared among Japanese teenagers who subsist on soft drinks, noodles, and polished rice (Kawai et aL, 1980). Macrobiotic vegetarians are prone to the neurologic complications of Bj2 efficiency after years of such a diet. 

A general guideline for the estimate of calorie requirements of burned children is 60 calories per kg per day plus an additional 30 calories for each 100 cm of burned area. Burned children are often anorexic, have delayed gastric emptying, and develop diarrhea with duodenal tube feeding. Severe malnutrition is therefore a frequent complication (Blocker et al., 1955 Levenson et al., 1945 Sutherland and Batchelor, 1968) of patients with burn injury and is associated with protein breakdown,delayed wound healing and infection which further increase caloric demands. 

The results of supplementary parenteral nutrition in twelve children between the ages of two to fourteen years with severe thermal injuries are reviewed. Ten of these patients suffered third degree burns involving 50 to 90% of the total body surface. One of the children with a 30%, burn had delayed healing due to severe malnutrition prior to his transfer to this hospital, i.e., loss of 50%. of body weight. Another, four year old patient with 30% burns suffered anoxic brain damage and was unconscious for a period of six weeks. 

Treatment and Prevention of Protein-Energy Malnutrition Emergency Care of Severely III Patients Treatment of Protein Depletion in Hospital Patients (With Trauma, Infection, Burns, or After Surgery) Correction of Mild to Moderate Protein-Energy Malnutrition Prevention of Protein-Energy Malnutrition Recent Developments in the Treatment and Prevention of Protein-Energy Malnutrition... 

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