Burns are often described as one of the most metabolically stressful injuries. Discuss the effects of a burn on metabolism and how this will affect nutritional requirements

What will be an ideal response?


Burns, as a type of severe injury or trauma, initiate the stress metabolic response. There is progression through three phases: the ebb phase, acute flow phase, and recovery phase or adaptive flow phase. The ebb phase occurs within the first 24-48 hours and it characterized by hemodynamic instability. This is a period of severe shock with depression of enzymatic activity and oxygen consumption, resulting in decreased cardiac output, decreased core temperature, and increased lactic acidosis. It is critical during this time to conduct fluid resuscitation and oxygen delivery. Thus, feeding this patient while he/she is still hemodynamically unstable is not a top priority for this stage.
During the acute flow phase, which occurs from 3 to 10 days after the initial stress event, the body is hypermetabolic with increased cardiac and oxygen consumption. Other changes include increased glucose production via gluconeogenesis, variable lipolysis, and increased protein breakdown to supply a gluconeogenic substrate. The body also uses amino acids from this muscle breakdown to create precursors for acute-phase proteins and glutamine for gut metabolism. This causes an increase in protein mobilization, increased urinary nitrogen excretion, and lean body mass wasting (weight loss). During this second phase, the body is activating its survival mechanisms to maintain organ systems and promote healing. Unfortunately, this also increases the risk for malnutrition and further complications to the initial event if not treated properly. The goal of this stage is to maintain nitrogen balance to prevent catabolism and the patient will require high levels of protein and energy with nutrition support.
During the last stage, the recovery/adaptive flow phase, the acute flow phase subsides and the initiation of recovery and the repair processes begin. This results in a decrease in energy and protein needs due to the decrease in inflammation and catabolism as anabolism begins to occur. This third phase can last up to two years after initial injury in extreme cases.

Nutritional Science

You might also like to view...

Infants younger than 6 months old with diarrhea should be given pear or apple juice because the sugars in these juices will reduce diarrhea, gas, and abdominal pain.

Answer the following statement true (T) or false (F)

Nutritional Science

Tom was overweight when he was 13 . During puberty he continued to gain weight steadily until at age 23, when he decided to lose weight. Tom successfully lost 50 pounds. Which of the following most likely happened to Tom's fat cells?

a. They shrank in size but did not decrease in number b. They melted away when he burned all the excess fat c. They decreased in number but did not decrease in size d. They changed very little since fat cells shrink only with a weight loss greater than 100 pounds

Nutritional Science

Which of the following amino acids is a dietary essential?

A. Alanine B. Aspartic acid C. Phenylalanine D. Serine

Nutritional Science

Mike should keep his sodium intake at or below _____ mg per day to help prevent heart disease

a. 1,000 b. 1,600 c. 2,000 d. 2,400 e. 2,700

Nutritional Science