Burns parenteral nutrition

Panthenol is frequently used in ointments and solutions for the treatment of burns, anal fissures, and inflammation of the conjunctiva. The vitamin has to be substituted in patients on total parenteral nutrition and in those who regularly undergo dialysis. Hypervitamin-osis has not been observed for doses up to 5 g/d (22). Furthermore, the administration of pantothenic acid leads to improved surgical wound healing due to its antiinflammatory properties. 

J. Larsson, St Liljedahl, J. Martensson, H. Nordstrom, B. Shildt and B. Sorbo, Urinary Excretion of Sulfur Amino Acids and Sulfur Metabolites in Burned Patients Receiving Parenteral Nutrition, J... 

Acute changes in behavior, impaired speech, visual field constriction, hearing loss, and somatosensory In patients undergoing total parenteral nutrition Acute, hair loss Burn patients exhibiting erythema... 

Larsson j, Liljedahl SO, Martensson J Nordstrom H, ScHiLDT B and Sorbo B (1982) Urinary excretion of suljur amino acids and suljur metabolites in burned patients receiving parenteral nutrition. J Trauma 22 656-663. 

Parenteral nutrition therapy is used for a severely burned patient. 

Food-drug interactions Parenteral nutrition In a literature review of all the evidence for and against interactions of antiepileptic drugs with parenteral nutrition, there was no [107 ] clear evidence supporting interactions, but several case reports and anecdotes have shown that alterations in the unbound fraction of antiepileptic drugs may result from combined administration with parenteral nutrition. This may be particularly important when there is hypoalbuminemia (for example, in patients with burns). 

The advent of parenteral nutrition has opened new avenues for therapy and prevention of malnutrition in these children. However, the technique of parenteral nutrition in burns poses several special problems. Because of the nature of the burned wound, sepsis is a particular hazard. Placement of the catheter is difficult especially when the burns involve the upper trunk and the arms. Whirlpool debridement may compromise sterility at the site of the catheter entrance. On the other hand, infusion of calories through peripheral veins limits the caloric concentration of the infusate and require large volume to meet nutritional needs. There is also an increased incidence of venous thrombosis whenever the dextrose concentration of the infusate exceeds 10%. Some of these complications can partially be prevented by simultaneous infusion of fat emulsion which in addition to their high caloric content also appear to protect peripheral veins from thrombosis. The reported experience with parenteral nutrition in burned children is limited and critical reviews are nonexistent. We have therefore presented the experience with parenteral nutrition of both the Cincinnati and Boston Units of the Shriners Burns Institute. 

The incidence of Candidiasis reported in this series is disturbing because of the recent association of Candidiasis with parenteral nutrition, by Ashcraft and Leape (5). The work of MacMillan, Law and Holder, however, documents the increasing problem of Candida in the burned child (6). Because of the number of variables involved, it is difficult in this series to assess the relationship between Candidiasis and central venous nutritional supplementation. The clinician caring for this type of patient, however, should be aware of this etiologic possibility when sepsis presents and treat when present by removing catheters and giving Amphotericin B. 

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. 

Glutamine deficiency occurs in critically ill patients, especially burn patients, as a result of increased protein turnover in the hypercatabolic state (56,57). Low levels of Glutamine on admission are associated with shock and increased hospital mortality and are more common in older persons (58). Glutamine supplementation in ICU patients was reviewed by the Italian Society of Enteral and Parenteral Nutrition (SINPE) (59), which noted that increased plasma glutamine levels were associated with improved outcomes in ICU patients. Other antioxidants such as parenteral selenium are also of interest in ICU patients (60). 

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