Metabolic changes and nutrition in burns patients

Extensive thermal injury elicits a metabolic response characterized by increased metabolic rate, nitrogen wasting, hyperthermia and weight loss. Neurohormonal alterations appear to both initiate and mediate this response and to influence the disposition and utilization of nutrients and energy substrates. The exaggerated nutritional needs of the severely burned patient must be satisfied by intensive alimentation regimens, utilizing the enteral route preferentially, but the parenteral route if necessary. Full metabolic support also includes prevention and control of infection, maintenance of muscle activity, control of pain to minimize further stress and the establishment of a warm microenvironment to minimize external heat loss.