Hypermetabolism and Management in Severe Burn Injury

Anna Cannata, Camille Primous, Kendra Appe, and Kelsea Moore Bastyr University

INTRODUCTION

Severe burns are accidental injuries with

detrimental and potentially life-threatening
effects

RESULTS

Metabolic Changes

Nutritional and Medical Treatments

It is considered severe if more than 20% of

total body area is burned
An efficient, multidisciplinary approach to
treating a severe burn injury is vital in
preventing mortality
Severe burn creates a hypermetabolic and
hypercatabolic state
Estimating % Burned Area

http://chemm.nlm.nih.gov/burns.htm

Shock, sepsis and

secondary
infections are
also of concern

1.

What are the metabolic changes that result

from severe burn injury?

2.

DISCUSSION

How Much Nutrition: Overfeeding is currently

accepted17,23

Severe burns lead to an inflammatory and

hypermetabolic response10,16,19,22

Delivery Method: Enteral Nutrition (EN) is preferred6,10

Macronutrient Distribution: High Carbohydrate, High

Protein, Low Fat diet is favored10,13

Treating these metabolic responses leads to

decreased morbidity and mortality10,18,21

Supplementation: Glutamine, Alanine, Arginine,

Antioxidants, and Trace Elements sometimes added3,7,9,15

Pharmaceuticals are used to treat different aspects of

hypermetabolism11,20

Skin Grafting Technique: improves all aspects of severe

burns and depends on burn size2

Future treatments: continually improve burn

recovery4,5,14

In the past 15
years there has
been a vast
improvement in
the survival rates
of patients with
severe burn
injury

METHODS

3.

RESULTS

Many current nutritional and medical

treatments address these concerns10,11
Prospective future treatments may continue
to increase survival rates and decrease
recovery time14
More studies are required for nutritional
therapies and further studies on medical
interventions should be assessed10

CONCLUSION
1. The inflammatory and endocrine responses
that result from a burn injury lead to
hypermetabolism, catabolism, stress-induced
insulin resistance and hyperglycemia

Figure 1: Metabolic
Changes in Patients
with Severe Burn Injury
Appe and Moore, 2014

Resting energy expenditure at 130-140% of normal12

What are the nutritional treatments for

severe burn injury?

Inflammatory response 12,8

Hyperglycemia and insulin resistance22

What are the medical interventions for

severe burn injury?

Proteolysis16 and lipolysis19

2. Nutritional treatment is constantly evolving

but currently enteral nutrition providing a
high carbohydrate, high protein, low fat diet
is supported
3. The current and Future medical interventions
work by improving hypermetabolism, wound
healing, and the inflammatory response
Table 1: Burn Treatments and Responses Cannata and Moore, 2014

INTRODUCTION
Estimating % Burned Area

Severe burns are accidental injuries with detrimental

and potentially life-threatening effects
It is considered a severe burn if more than 20% of
total body area is burned*
An efficient, multidisciplinary approach to treating a
severe burn injury is vital in preventing mortality
Severe burn creates a hypermetabolic and
hypercatabolic state
Shock, sepsis and secondary infections are also of
concern

http://chemm.nlm.nih.gov/burns.htm

In the past 15 years there has been a vast

improvement in the survival rates of patients with
severe burn injury

METHODS
1.What are the metabolic changes that result from severe burn injury?

2.What are the nutritional treatments for severe burn injury?

3.What are the medical interventions for severe burn injury?

RESULTS: Metabolic Changes

Resting energy expenditure at 130140% of normal12

Inflammatory response 12,8
Hyperglycemia and insulin
resistance22
Proteolysis16 and lipolysis19

Figure 1: Metabolic Changes in

Patients with Severe Burn Injury
Appe and Moore, 2014

RESULTS: Nutritional Therapies

Table 1: Burn Treatments and Responses

Cannata and Moore, 2014

How Much Nutrition:

Overfeeding is currently
accepted17,23
Delivery Method: Enteral
Nutrition (EN) is
preferred6,10
Macronutrient Distribution:
High Carbohydrate, High
Protein, Low Fat diet is
favored10,13
Supplementation:
Glutamine, Alanine,
Arginine, Antioxidants, and
Trace Elements sometimes
added3,7,9,15

RESULTS: Medical Therapies

Pharmaceuticals are used to
treat different aspects of
hypermetabolism11,20
Skin Grafting Technique:
improves all aspects of severe
burns and depends on burn
size2
Future treatments: continually
improve burn recovery4,5,14

Table 1: Burn Treatments and Responses

Cannata and Moore, 2014

DISCUSSION
Severe burns lead to an inflammatory and hypermetabolic
response10,16,19,22
Treating these metabolic responses leads to decreased
morbidity and mortality10,18,21
Many current nutritional and medical treatments address
these concerns10,11

Prospective future treatments may continue to increase

survival rates and decrease recovery time14
More studies are required for nutritional therapies and
further studies on medical interventions should be
assessed10

CONCLUSION
1.The inflammatory and endocrine responses that result from a burn injury lead to
hypermetabolism, catabolism, stress-induced insulin resistance and hyperglycemia
2.Nutritional treatment is constantly evolving but currently enteral nutrition providing a
high carbohydrate, high protein, low fat diet is supported
3.The current and Future medical interventions work by improving hypermetabolism,
wound healing, and the inflammatory response

REFERENCES
1.

Al-Mousawi, 2010

13. Lee, 2011

2.

Atiyeh, 2005

14. Liu, 2014

3.

Berger, 2011

15. Pattanshetti, 2009

4.

Branski, 2014

16. Prelack, 2010

5.

Brown. 2013

17. Rimdeika, 2006

6.

Chen, 2007

18. Rodriguez, 2011

7.

Fan, 2009

19. Traber, 2010

8.

Finnerty, 2014

20. Tuvdendorj, 2011

9.

Guo, 2010

21. Williams 2011

10. Hall, 2012

22. Wolfe, 1979

11. Herndon, 2001

23. Xi, 2014

12. Jeschke, 2008

For full references, please see annotated bibliography