8.4 Burn Injury and Wound Healing Nutrition Support
4 min read•july 30, 2024
Burn injuries trigger a hypermetabolic state, causing increased catabolism and altered hormone levels. Patients require high-calorie, to support wound healing and counteract muscle wasting. Micronutrient needs also skyrocket due to oxidative stress and healing demands.
Nutritional support is crucial for burn patients and those with severe wounds. Energy requirements soar, often doubling baseline needs. Protein intake must increase to 1.5-2.5 g/kg/day. Key nutrients like , , and arginine play vital roles in collagen formation and immune function during healing.
Nutritional Needs in Burn Patients
Metabolic Changes in Burn Injuries
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Top images from around the web for Metabolic Changes in Burn Injuries
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Frontiers | Adipose Tissue Metabolic Function and Dysfunction: Impact of Burn Injury View original
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- Burn injuries trigger a hypermetabolic state characterized by increased catabolism, elevated resting energy expenditure, and altered hormone levels
- Protein breakdown accelerates in burn patients leads to and muscle wasting
- Burn-induced occurs due to insulin resistance and increased gluconeogenesis necessitates careful glucose management
- Fluid and electrolyte imbalances commonly occur in burn patients require careful monitoring and replacement strategies
- Sodium and potassium levels fluctuate dramatically
- Fluid shifts can lead to edema or dehydration
Increased Nutritional Requirements
- Micronutrient requirements significantly elevate in burn patients due to increased oxidative stress and wound healing demands
- Vitamin A needs increase to support epithelial regeneration
- Vitamin C requirements rise to aid collagen formation
- Vitamin D helps regulate immune function
- Zinc demands increase to support enzyme function and protein synthesis
- High-calorie, high-protein diets support wound healing and counteract catabolism in burn patients
- Calorie needs may increase up to 100% above baseline
- often range from 1.5-2.5 g/kg/day
- Early enteral nutrition maintains gut integrity and supports immune function in burn patients
- Initiate within 24-48 hours of injury when possible
- reserved for specific cases (severe GI dysfunction)
Energy and Protein for Wound Healing
Calculating Energy Requirements
- Energy requirements for wound healing elevate significantly above baseline needs
- Predictive equations calculate energy needs adjusted for injury severity
- Harris-Benedict equation with injury factors
- Curreri formula for burn patients:
- Account for additional factors when determining energy needs
- Fever increases energy expenditure (13% per degree Celsius above 37°C)
- Activity level impacts overall calorie requirements
- Wound size and depth influence metabolic demands
Protein and Amino Acid Needs
- Protein needs significantly increase during wound healing to support tissue repair and immune function
- Requirements often range from 1.5 to 2.0 g/kg body weight per day
- Severe burns or large wounds may require up to 2.5 g/kg/day
- Essential amino acids play crucial roles in wound healing
- Arginine promotes collagen synthesis and supports immune cell function
- Glutamine aids in maintaining gut integrity and immune response
- Branched-chain amino acids (leucine, isoleucine, valine) support protein synthesis
- Monitor nitrogen balance to assess adequacy of protein intake
- Aim for positive nitrogen balance to support anabolism
- Calculate using 24-hour urinary urea nitrogen and dietary protein intake
Nutrition Care for Burn Injuries
Comprehensive Nutrition Assessment
- Conduct anthropometric measurements to assess nutritional status
- Weight changes (accounting for fluid shifts)
- Skin fold thickness and mid-arm muscle circumference
- Evaluate biochemical data for nutritional markers and metabolic status
- Prealbumin and transferrin for protein status
- Electrolytes, glucose, and lipid profiles
- Assess clinical symptoms related to nutritional status and burn severity
- Wound appearance and healing progress
- Presence of edema or dehydration
- Analyze dietary intake through food records or recall methods
- Compare intake to calculated requirements
- Identify potential nutrient deficiencies or excesses
Implementing Nutrition Support
- Determine appropriate route of nutrition support based on patient condition
- Oral diet with supplements for mild cases
- Enteral nutrition for moderate to severe burns
- Parenteral nutrition when enteral route is contraindicated
- Design meal plan or enteral formula meeting calculated macro and micronutrient needs
- High-protein, high-calorie formulas for severe burns
- Immune-enhancing formulas with arginine, glutamine, and omega-3 fatty acids
- Implement optimal feeding schedule to maximize nutrient utilization
- Small, frequent feedings for oral diets
- Continuous or bolus enteral nutrition based on tolerance
- Establish monitoring protocol to assess nutritional status and wound healing progress
- Regular anthropometric measurements
- Biochemical markers of nutritional status
- Wound healing assessment tools (PUSH score)
Nutrients for Wound Healing
Essential Micronutrients
- Vitamin C vital for collagen formation and immune function in wound healing
- Requirements often increase to 500-2000 mg/day for severe wounds
- Supports hydroxylation of proline and lysine in collagen synthesis
- Zinc essential for protein synthesis and cell proliferation during wound healing
- Supplementation recommended for large wounds or delayed healing
- Typical doses range from 15-30 mg/day elemental zinc
- Vitamin A supports epithelialization and immune function in wound healing
- Requirements potentially increase to 10,000-25,000 IU/day for extensive wounds
- Enhances early of wound healing
- Adequate hydration crucial for optimal wound healing
- Supports circulation and nutrient delivery to healing tissues
- Monitor fluid balance and adjust intake based on wound drainage
Specialized Nutrients and Supplements
- Arginine and glutamine supplementation enhances wound healing
- Arginine supports collagen synthesis and immune function
- Glutamine aids in maintaining gut integrity and immune response
- Omega-3 fatty acids modulate inflammatory response in wound healing
- EPA and DHA in appropriate ratios to omega-6 fatty acids
- Typical doses range from 1-2 g/day of combined EPA and DHA
- Vitamin E acts as antioxidant in wound healing process
- Reduces oxidative stress in healing tissues
- Typical supplementation ranges from 100-400 IU/day
- Copper plays crucial role in cross-linking collagen and elastin
- Supplementation beneficial in cases of deficiency or impaired healing
- Usual doses range from 1-3 mg/day
- Specialized amino acid mixtures support wound healing in catabolic patients
- β-hydroxy-β-methylbutyrate (HMB) helps preserve lean body mass
- Typical doses of HMB range from 1.5-3 g/day
Key Terms to Review (20)
Caloric supplementation: Caloric supplementation refers to the process of providing additional calories to individuals, often through specialized nutrition formulas, to meet increased energy needs due to factors like illness or injury. This approach is particularly important for patients recovering from conditions such as burn injuries, where the body requires significantly more energy to support healing and repair processes. By ensuring adequate caloric intake, caloric supplementation plays a crucial role in promoting optimal recovery and maintaining nutritional status during the healing journey.
Electrolyte balance: Electrolyte balance refers to the proper concentration and distribution of essential minerals in the body fluids, which is crucial for maintaining various physiological functions. This balance is vital for nerve conduction, muscle contraction, hydration, and acid-base equilibrium. Imbalances can lead to significant health issues, particularly in patients recovering from illness, experiencing burn injuries, or requiring nutritional support via parenteral methods.
Enteral Feeding: Enteral feeding is a method of delivering nutrition directly to the gastrointestinal tract through a tube, allowing individuals who cannot consume food orally to receive essential nutrients. This approach can be critical for patients with various medical conditions, providing a means to meet their nutritional needs effectively while minimizing the risk of aspiration and ensuring proper digestion.
Fluid resuscitation: Fluid resuscitation is the process of replenishing bodily fluids lost due to injury, illness, or surgery to restore adequate blood volume and circulation. It is especially crucial in burn injuries where fluid loss occurs rapidly due to damaged skin and increased vascular permeability. By providing the right type and amount of fluids, healthcare providers can prevent shock, maintain organ function, and support the healing process.
High-protein diets: High-protein diets are eating plans that emphasize consuming a higher proportion of protein compared to other macronutrients like carbohydrates and fats. These diets can be crucial in various medical contexts, especially for individuals recovering from injuries or surgeries, those dealing with malnutrition or sarcopenia, and patients undergoing renal treatment, as protein plays a vital role in tissue repair, muscle maintenance, and overall health.
Hyperglycemia: Hyperglycemia is a condition characterized by elevated levels of glucose in the bloodstream, often resulting from insufficient insulin production or action. This condition can significantly affect metabolic processes and is particularly important in managing patients with critical illnesses, such as those experiencing burn injuries or receiving enteral and parenteral nutrition.
Hypermetabolism: Hypermetabolism is a state characterized by an increased metabolic rate, where the body uses energy at an accelerated pace, often in response to stress, illness, or injury. This heightened metabolic demand can significantly impact nutritional needs and energy balance, especially in individuals facing serious health conditions.
Hypoproteinemia: Hypoproteinemia refers to a condition characterized by abnormally low levels of proteins in the blood. This condition can significantly affect wound healing and recovery from injuries, particularly in burn patients, as adequate protein levels are essential for tissue repair and immune function. Understanding hypoproteinemia is crucial in providing appropriate nutrition support for individuals with wounds or burns, as it can influence overall recovery outcomes and the body's ability to heal.
Increased Caloric Intake: Increased caloric intake refers to the consumption of more calories than the body requires for maintenance and normal functioning. This concept is particularly relevant in the context of burn injuries, where the body experiences heightened energy demands due to the metabolic stress of healing and recovery, necessitating a significant increase in caloric intake to support tissue repair and regeneration.
Infection risk: Infection risk refers to the likelihood of developing an infection, particularly in individuals with compromised skin integrity or weakened immune systems. In the context of burn injuries and wound healing, infection risk is heightened due to the loss of the skin's protective barrier, making it easier for pathogens to enter the body. This increased susceptibility can impede healing and lead to serious complications, emphasizing the need for careful monitoring and nutrition support to bolster the immune response.
Inflammatory phase: The inflammatory phase is the initial stage of wound healing characterized by the body's immediate response to injury, marked by inflammation, increased blood flow, and the accumulation of immune cells at the site of damage. This phase is crucial for protecting the body against infection and begins within minutes of injury, lasting for several days as the body works to clear debris and prepare for tissue repair.
Malnutrition Screening Tool: A malnutrition screening tool is a systematic method used to identify individuals at risk of malnutrition due to factors such as inadequate intake or increased nutritional needs. It typically involves a brief assessment of dietary intake and clinical parameters to help healthcare professionals recognize patients who may require further nutritional evaluation or intervention, especially in settings like burn injury and wound healing, where nutritional status can significantly impact recovery and healing outcomes.
Negative Nitrogen Balance: Negative nitrogen balance occurs when the amount of nitrogen excreted from the body exceeds the amount of nitrogen consumed through dietary protein. This state indicates that the body is breaking down more protein than it is synthesizing, often due to conditions such as illness, malnutrition, or stress. It is particularly relevant in understanding muscle wasting, impaired healing, and overall catabolic states that can arise from various health issues.
Parenteral Nutrition: Parenteral nutrition is a medical method of delivering nutrients directly into the bloodstream, bypassing the gastrointestinal tract. This approach is crucial for patients who are unable to consume food orally or have non-functioning digestive systems, providing them with essential nutrients like carbohydrates, proteins, fats, vitamins, and minerals to support their health and recovery.
Proliferative phase: The proliferative phase is a critical stage of wound healing characterized by tissue formation, where new cells proliferate to replace damaged tissue. This phase typically follows the inflammatory phase and is essential for restoring the integrity of the skin and other affected tissues, making it particularly important in the context of burn injuries.
Protein requirements: Protein requirements refer to the amount of protein that the body needs to maintain optimal health, particularly during times of stress, illness, or injury. These needs can significantly increase due to metabolic changes that occur in the body, which affects how protein is used for repair, recovery, and overall maintenance of bodily functions. Understanding protein requirements is crucial in various clinical scenarios, where ensuring adequate intake can improve outcomes in patients facing challenges such as sepsis, multi-organ failure, severe burns, and developmental needs in children.
Subjective Global Assessment: Subjective Global Assessment (SGA) is a clinical tool used to evaluate a patient's nutritional status based on a combination of medical history, physical examination, and subjective criteria. It helps identify malnutrition by assessing weight changes, dietary intake, gastrointestinal symptoms, and functional capacity, making it crucial in various medical contexts.
Vitamin C: Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that is essential for the growth and repair of tissues in the body. It plays a vital role in the synthesis of collagen, a protein that helps maintain skin, cartilage, tendons, ligaments, and blood vessels. Additionally, vitamin C is an antioxidant that helps protect cells from damage by free radicals and supports the immune system.
Wound Dehiscence: Wound dehiscence refers to the surgical complication where a wound ruptures or separates along the surgical incision line. This can occur due to various factors including inadequate healing, infection, or excessive tension on the wound. Understanding wound dehiscence is crucial in the context of burn injuries and wound healing, as it can significantly hinder the recovery process and increase the risk of further complications.
Zinc: Zinc is an essential trace mineral that plays a crucial role in numerous biological functions, including immune response, protein synthesis, wound healing, and DNA synthesis. Its significance extends to various health conditions, as zinc deficiency can lead to impaired immune function and delayed wound healing, making it vital in managing health and disease.