Burn patient protein requirements

Protein metabolism depends on both kidney and liver function therefore, protein requirements will be altered with decreased kidney or liver function (see Chap. 139). Critical illness (e.g., sepsis, burns, or trauma) will result in a hypercatabohc state in which there is increased protein synthesis and degradation. Consequently, protein requirements wiU be increased to 1.5 to 2 g/kg per day. In burn patients, protein requirements may be as high as 2.5 to 3 g/kg per day. Liver failure typically results in the need for protein restriction (0.5 g/kg per day) except if a hypercatabohc state is also present, in which case the requirement may be increased to 1.5 g/kg per day. Protein needs in renal failure are variable and affected by the various renal replacement therapies available. The apphcation of these guidelines requires both chnical judgment and frequent monitoring of renal and liver function, serum chemistries, chiucal condition, and nutrition outcomes (see Chap. 139). 

Protein requirements are based on age, nutrition status, disease state, and clinical condition. The usual recommended daily protein allowances are 0.8 g/kg for adults, 1.5 to 2 g/kg for patients with metabolic stress (e.g., infection, trauma, and surgery), and 2.5 to 3 g/kg for patients with burns. See Table 57-5 for recommendations for children. 

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. 

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