Trace elements are present in the body in amounts less than one part per million by weight; many are essential components of metalloenzymes. Following burn injury, significant amounts of these trace elements may be lost. The acute phase reaction is characterized by a decrease in plasma levels of copper, iron, selenium, and zinc and an increase in the plasma levels of the carrier proteins ferritin and caeruloplasmin. Although iron levels decline following burn trauma, it has been shown that excessive administration of iron is harmful and that low plasma levels of iron appear to be of benefit in reducing microbial replication. In contrast, increased intravenous administration of copper, zinc, and selenium during the first week following burn injury resulted in fewer complications, an improved leucocyte response, a rapid return of the plasma levels of these trace minerals, as well as a shorter hospital stay. Zinc, copper, and manganese are essential for wound healing; serum zinc levels decrease following stress and burn injury largely due to increased urinary loss. Zinc supplementation, 220 mg daily, should be considered for all patients with major burns. Inclusion of trace elements in both enteral and parenteral nutrition is essential.
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