Estimating the nutritional needs of burn patients is an essential to the healing process. There are several formulas for determining the nutritional needs for burn patients. The Harris-Benedict equation is designed to calculate the calorie needs of adults where as the Galvaston formula is used for children. The Curreri formula addresses the needs for adults and children. Recent studies have shown that these formulas tend to overestimate the calorie needs of patients by 150%. Because there is not one formula that can accurately determine how many calories that a patient needs it is important for doctors and dietitians to closely monitor a patient's nutritional condition.
Protein requirements generally increase more than energy requirements and appear related to the amount of lean body mass. The body loses protein through wounds and because of this, the body has increased calorie needs for healing. However, the majority of increased protein requirements come from muscle breakdown for use in energy production. Providing an increased intake of protein does not stop this breakdown. Rather it provides the materials needed to synthesize lost tissue.
Carbohydrates provide the majority of calorie intake under most conditions, including the stress of burns. Providing adequate calories from carbohydrates spares incoming protein from being used for fuel. The body breaks down carbohydrates into glucose that the body then uses for energy. Burn wounds require glucose for energy and can not use alternate sources of energy.
Fat is needed to meet essential fatty acid requirements and provide needed calories. Common recommendations include giving 30% of calories as fat, though this can be higher if needed. Excess fat intake has been implicated in decreased immune function and intake levels should be monitored carefully.
Most healthcare professionals note that burn injury necessitates increased vitamins and minerals but the amounts remain poorly defined. Many vitamins are involved including Vitamin C and E, along with Zinc may limit oxidative damage and promote wound healing.
Pediatric Burn Nutrition
Providing adequate calories and nutrients is a difficult task when treating burn injuries. This task becomes even more difficult when the patient is a child. It is essential for healthcare professionals to meet the patients nutritional needs in order to minimize the devastating effects of loss of lean body mass and depletion of energy and protein reserves. A failure to meet these needs may result in impaired wound healing, negative nitrogen balance, weight loss and decreased immune function.
An initial nutritional assessment is done as soon as possible after admission to the hospital. This is done early in burn treatment so that appropriate feedings can be initiated within the first 24 to 48 hours after the patient was burned. An accurate height and weight as well as pre-burn measurements, which are plotted on a standard pediatric growth chart are needed to determine a child's nutritional needs.
Doctors will prescribe a high protein, high carbohydrate diet for the patient. The nutritional plan will also provide the patient will an adequate amount of fats, that will help to increase immune function. Additionally, a vitamin and mineral supplements will be given to the patient.
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