Which of the following is true regarding nutritional needs ofburn patients?
A. The hypermetabolic response to burn wounds typically raises the basic metabolic rate by 120%The hypermetabolic response in burn injury may raise baseline metabolic rates by as much as 200%. This can lead to catabolism of muscle proteins and decreased lean body mass that may delay functional recovery. Early enteral feeding for patients with burns larger than 20% TBSA is safe, and may reduce loss of lean body mass, slow the hypermetabolic response, and result in more efficient protein metabolism. Calculating the appropriate caloric needs of the burn patient can be challenging. A commonly used formula in nonburned patients is the Harris-Benedict equation, which calculates caloric needs using factors such as gender, age, height, and weight. This formula uses an activity factor for specific injuries, and for burns, the basal energy expenditure is multiplied by two. The Harris-Benedict equation may be inaccurate in burns of less than 40% TBSA, and in these patients the Curreri formula may be more appropriate. This formula estimates caloric needs to be 25 kcal/kg/day plus 40 kcal/% TBSA/ day.
The anabolic steroid oxandrolone has been extensively studied in pediatric patients as well, and has demonstrated improvements in lean body mass and bone density in severely burned children. The weight gain and functional improvements seen with oxandrolone may persist even after stopping administration of the drug. A recent double-blinded, randomized study of oxandrolone showed decreased length of stay, improved hepatic protein synthesis, and no adverse effects on the endocrine function, though the authors noted a rise in transaminases with unclear clinical significance.