Catabolic Response

Release of gluconeogenic amino acids from skeletal muscle results in loss of muscle mass. Deamination of these amino acids, during the generation of carbon skeletons for glucose synthesis, increases nitrogen production with subsequent conversion to urea, which is excreted by the kidneys. Urinary nitrogen loss following thermal injury is largely from skeletal muscle breakdown, but a significant contribution of approximately 25-30% comes from the burn exudate. The rate of nitrogen loss is related to total burn area (TBA) and can be as much as 3 or 4g/kg/day at its peak (Figure 3). These high rates of nitrogen loss persist for the first 7-10 days and then gradually decline until the burn area is healed and

5 10 15 20 25 30 35 g/day Urinary nitrogen loss; normal approx 8 g/day

Figure 3 Nitrogen losses increase in thermally injured patients and remain high for a longer period than for any other injury. (Adapted with permission from Long CL, Schaffel N, Geiger JW et al. (1979) Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance. Journal of Parenteral and Enteral Nutrition 3(6): 452-456.)

5 10 15 20 25 30 35 g/day Urinary nitrogen loss; normal approx 8 g/day

Figure 3 Nitrogen losses increase in thermally injured patients and remain high for a longer period than for any other injury. (Adapted with permission from Long CL, Schaffel N, Geiger JW et al. (1979) Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance. Journal of Parenteral and Enteral Nutrition 3(6): 452-456.)

body stores of nitrogen are replenished; this may take many months. Nutritional support provides an exogenous source of calories and protein, which limits autocanabalism of skeletal muscle with a reduction in infective complications, increased survival rates, and reduced hospital stay.

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