Burn Injury Nutrition

Burn Injuries Nutrition & Support

Nutritional support is a vital component when treating a burn injury. Nutrition represents one of the most important cornerstones in the management of patients with a moderate to severe burn injury. Clinical monitoring is the key tool for assessing the adequacy of nutritional support and includes reviewing the nutritional intake in burn patients. Speak to your physician, nutritionist, or registered dietitian concerning the types of nutrition support recommended and calculating the recommended caloric requirements for you.

Patients with a surface burn of 40% can lose 25% of preadmission weight in 3 weeks without nutrition support.  A lack of nutritional support for burn injury patients can reflect a significantly poorer outcome, including impaired immunity and delayed healing.

Parameters used to evaluate the clinical course of a burn injury include hemodynamic stability, respiratory status, functional status, evidence of infection or sepsis, and ensuring a diet that is tolerating to the patient.

Speak to your physician or nutritionist about the burn injury nutritional drink supplement that is right for you.

 

Burn Injury Nutrition

Energy and Macro-nutrient Support

To aid recovery, nutritional support will help reduce your weight loss and strengthen the immune system. Recommended daily energy intake is as follows: 5 for adults, 25 calories per kilogram plus 40 calories per each percent of burn area; for children, 1,800 calories plus 2,200 calories per m2 of burn area. Individualized nutrition assessment by your healthcare professional is recommended for patients with burns on >20% of TBSA.

A burn injury drink supplement or in some case an enteral burn injury supplement can be vital to provide the nutrients needed for the immune system and healing support for the body. Enteral nutrition support with a high–protein, high–carbohydrate diet is recommended, and timing may be critical. Feedings started within ~ 4 to 36 hours following injury appear to have advantages over delayed (> 48 hours) feedings. If patients are hemo-dynamically stable (a prerequisite for prevention of bowel ischemia), these benefits include reductions in sepsis associated with gut permeability and clinical infection, as well as significantly shortened hospital stays. Enteral support can reduce the burn–related increase in secretion of catabolic hormones and help maintain gut mucosal integrity. The duodenal route is better tolerated than gastric feeding, due to an 18% failure rate in the latter from regurgitation. Total parenteral nutrition (TPN) is not recommended, due to its ineffectiveness in preventing the catabolic response to burns. TPN also impairs immunity and liver function and increases mortality, when compared with enteral nutrition.

High–carbohydrate, low–fat diets for burn patients result in less proteolysis and more improvement in lean body mass, compared with high–fat diets, and may reduce infectious morbidity and shorten hospitalization time, when compared with a high–fat regimen. The benefits of a high–carbohydrate formula must be balanced against the risk for hyperglycemia, which can negatively influence the outcome of critically ill patients. Nearly all burn patients experience insulin resistance as part of their hyper metabolic response and will need to be placed on an insulin drip to maintain tight control of their blood glucose level.

High protein burn injury drink supplements can help with the needed protein.  Protein intake as well as fluid intake are important to be considered carefully. Protein oxidation rates are 50% higher in burn patients, and protein needs are ~1.5 to 2.0 grams/kg. Water loss can be as much as 4 liters/m2/day, and a range of 30 to 50 ml/hour is given depending on urine output.

 

Micro-nutrient Support

Additional vitamin–mineral supplements may be indicated. Levels of the fat–soluble vitamins A and E and carotenoids fall below normal in burn injury patients. Vitamin E treatment reduced elevation in lipid peroxide levels in burn patients, although improved outcome was not noted as a result. Vitamin D synthesis is impaired in the skin of burn patients, both acutely and long–term. Blood levels appear to continue to fall, are below the normal range several years after recovery, and may negatively affect lumbar spine bone mineral density. Consequently, supplementation with the recommended dietary allowance of 400 IU per day has been suggested for patients with significant burns.

Patients with major burns also suffer acute trace–element deficiencies, at least partly because of large exudative losses through the burned areas. A lack of certain trace elements (eg, selenium and zinc) can exacerbate poor immunity, and burns are the second–leading cause of immunodeficiency, after HIV infection. Although a role for free radicals and lipid peroxides in burn trauma has been established, little research has been done on the effects of antioxidant supplements in human burn injury. However, the addition of selenium, zinc, and copper to a standard trace element formula and enteral nutrition was associated with a significant decrease in the number of bronchopneumonia infections and with a shorter hospital stay.

The burn patients response to nutrition intake should be evaluated weekly or even biweekly. However, standard measures of nutritional repletion, such as visceral proteins (eg, albumin, pre–albumin), are influenced not only by nutritional status, but also by inflammatory processes. When low concentrations are observed, the simultaneous concentrations of acute phase reactants, such as C reactive protein, must be compared with their own reference standard to separate nutritional from inflammatory effects._

 

Support From Family & Friends

Burn injuries can be very traumatic and it is very important for the family to know that the patient will need support.  Support, especially for deep partial–thickness (2nd degree) and full–thickness (3rd or 4th degree) burns, is vital for the patient. In severe burns, the patient may be physically incapacitated and emotionally traumatized. Usually burn patients will be in the hospital 1 to 2 days for each percent of total body surface area burned. The family can play an essential role supporting the patient. The support from family and friends during recovery is very important. Nutrition for healing burns is also vital for recovery.

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