Nutritional support is considered as a critical component in the treatment and wound healing of patients suffering from burn injuries (second and third degree burns). The aim of the nutritional support is to provide enough nutrients and supplements either enteral (feeding using the gastrointestinal tract such as oral or feeding tube) and/or parenteral (intravenous infusion) to meet the body demands in response to the metabolic changes that happen in moderate to severe burns. It have been shown that the early introduction of enteral feeding in the burned patients is vital for survival (Rodriguez et al, 2011).
When a burn happens and depending on the severity of the burn, the body react to the injury by increasing the production and secretion of certain hormones which in turn cause an increase in the metabolic demand (hypermetabolic response) that will result in the need of more nutritional support which may sometimes be accompanied by alteration in the carbohydrate, protein and fat breakdown.
The nutritional needs of the patient can be assessed in many ways taking into consideration many factors including the age of the patient, body weight, the percentage of the body surface area burned among other factors. The Curreri formula is used for adults and children. The Harris-Benedict formula is used for adults and the Galvaston formula used for children. Dietitians and treating doctors will assess, monitor, and adjust the nutritional needs frequently as the patient’s condition improves or deteriorates.
There are different ways of delivering these nutrients to the patients, depending on the burn severity and the condition of the patient. The patient may be fed by mouth, through the veins, through a tube in the intestinal tract or a combination of more than one method.
It is important to provide enough amount of carbohydrates to supply the energy needed and to spare proteins from being broken down and used as a source of energy. Carbohydrates make up the bulk of the nutrition and provide the majority of calorie intake. These carbohydrates will be turned by the body into glucose that will be used by the burn wounds as a source of energy. Carbohydrates will provide the energy for healing allowing protein eaten to be used to rebuild muscles rather than being used as a source of fuel.
The provision of adequate amount of proteins is essential to replenish the depleted protein stores because of the loss of proteins through the burn wound. Proteins are also important to rebuild the muscles as the muscle tissue is broken down during the healing process to produce the extra energy needed for healing.
Fat is also needed to provide essential amino acids (essential amino acids are amino acids that the body can’t synthesize and has to be supplied) and extra calories, it is recommended that no more than 30% of calories come from fat; too much fat can result in significant stress on the liver as well as weaken the immune system.
4- Vitamins and minerals:
After a burn injury, it has been found that patients have reduced levels of iron, zinc, copper and selenium as well as vitamins A, C, E and D. These vitamins and minerals play a role in wound healing, immune response and preventing free radicals from causing damage to the tissues. Decrease of the level of these elements may lead to reduced immune function and poor wound healing.
- Burned infants and children represent more complex diet therapy challenges because in addition to the increased nutritional needs imposed by the burn, growth and developmental requirements must be considered. The patient will be assessed and nutritional needs will be calculated as soon as possible after hospital admission.
- Parents have an important role in the healing process and in encouraging their child to eat, parents after consulting with child’s physician and dietitian can bring the child’s favorite food and have to praise the child even when small amount of food eaten.
- It is important to follow the instructions given to you at the time of discharge as some patients may be discharged home with special instructions regarding nutritional requirements.
This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.