Wound

Metabolic response Increased glucose flux Glycogenolysis Gluconeogenesis Increased futile cycles Fat mobilization Skeletal muscle breakdown

Inflammatory response Leucocyte activation Cytokine production Growth factor production Chemotactic factor production

Figure 1 Schematic representation of the central nature of the burn wound in triggering physical, hormonal, metabolic, and inflammatory responses.

increase, although an apparent insulin resistance develops in peripheral tissues. There is an increase in core temperature, which appears to be mediated centrally by the hypothalamus in response to cyto-kine release, possibly interleukin-1 (IL-1). Plasma levels of glucose are maintained and may even increase, although glucose flux is greatly increased. Metabolic demands for glucose and amino acids increase and the body responds to meet these demands (Table 1). The degree of hypermetabolism and oxygen consumption are closely related to the extent and depth of burn injury. As a result, basal energy expenditure increases and is doubled for a 60% burn (Figure 2). Catecholamines augment

Table 1 Metabolic and circulatory responses to burn injury

Wound

Whole body

Damage

Increase in catecholamines, cortisol,

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