S A Hill, Southampton General Hospital,
© 2005 Elsevier Ltd. All rights reserved.
Of all insults to the body, burns elicit the most profound stress response. This response encompasses hormonal, metabolic, and immunologic changes, which are complicated by the loss of the many protective functions of an intact skin. The initial hypermetabolic state induces intense protein catabolism, which must be checked by aggressive nutritional support in order to limit morbidity and mortality. Following this intense period of catabolism, which lasts 10-14 days, there is a gradual reduction in the metabolic rate, catabolic processes decrease, the wound heals, and anabolic processes predominate. Nutritional support must also continue throughout these latter stages, which may take many weeks, so that anabolism can be supported and fuel reserves replenished. A diet high in carbohydrate (CHO) and protein but low in fat will not only suppress catabolism and favor anabolism but also support an appropriate immunological response.
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