Estimating the nutritional needs of burn patients is essential to the healing process. There are several formulas for determining the nutritional needs of burn patients. The Harris-Benedict equation is designed to calculate the caloric needs of adults, whereas the Galveston formula is used for children. The Curreri formula addresses the needs of both adults and children.
Recent studies have shown that these formulas tend to overestimate the caloric needs of patients by 150%. Because there is not one formula that can accurately determine necessary calories, it is important for doctors and dietitians to closely monitor a patient’s nutritional condition.
In general, the need for protein increases more than the need for energy, and this appears to relate to the amount of lean body mass. The body loses protein through wounds, and because of this, it has an increased caloric need for healing. However, the majority of increased protein requirements come from muscle breakdown for use in energy production, and providing an increased intake of protein does not stop this breakdown. Instead, it provides the materials needed to synthesize lost tissue.
Carbohydrates provide the majority of calorie intake under most conditions, including the stress of burns. Providing adequate calories from carbohydrates spares incoming protein from being used for fuel. The body breaks down carbohydrates into glucose that the body then uses for energy. Burn wounds require glucose for energy and cannot use alternate sources of energy.
Fat is needed to meet essential fatty acid requirements and provide necessaru calories. 30% of calories are recommended to come from fat, although this can be higher if needed. Too much fat can decrease immune function, so intake levels should be monitored carefully.
Most healthcare professionals note that burn injuries require increased vitamins and minerals, but the amounts remain poorly defined. Many vitamins are involved, including vitamin C and E and zinc, which may limit oxidative damage and promote wound healing.
Pediatric Burn Nutrition
Providing adequate calories and nutrients is a difficult task when treating burn injuries. This task becomes even more difficult when the patient is a child. It is essential for healthcare professionals to meet the patient’s nutritional needs in order to minimize the devastating effects of lean body mass loss and the depletion of energy and protein reserves. Failure to meet these needs may result in impaired wound healing, negative nitrogen balance, weight loss, and decreased immune function.
An initial nutritional assessment is done as soon as possible after admission to the hospital. This is done early on in burn treatment so that appropriate feedings can be initiated within the first 24 to 48 hours after the burn. Accurate height and weight as well as pre-burn measurements, which are plotted on a standard pediatric growth chart, are needed to determine a child’s nutritional needs.
Doctors will prescribe a high protein, high carbohydrate diet for the patient that also includes an adequate amount of fat, which will help to increase immune function. Additionally, vitamin and mineral supplements will also be given to the patient.