- ‘Clashal’ aggressive nutritional support is recommended following burn injury. All patients with burns should start oral feeds as soon as possible after initial.
- Oral fluids given should be 1/4th of daily normal requirement and this should be slowly increased to normal daily requirement which should include extra water loss from burn surface.
- All burn patients after 24-48 hrs should start on oral hyper-alimentation. Many formulae are available for protein and caloric requirement of the patients.
Table -1: Currier formulae for calorie & protein requirement in burns.
|Adult||20Kcal X Body wt.(kg) +70 Kcal X % TBSA burns||1gm X body wt.(kg) + 3 gm X %TBSA burns|
|Children||60Kcal X Body wt.(kg) +35 Kcal X % TBSA burns||3gm X body wt.(kg) + 1 gm X %TBSA burns|
- This high requirement is difficult to maintain orally, therefore in initial phase balanced diet of high protein and high calories is given intravenously to supplement oral intake.
- Protein should form 25% of energy requirement of burn patients. Glucose reduces the extent of hyper metabolic response and protein breakdown.
- Hence carbohydrate should form major part of the diet. It is recommended to give 50% of energy requirement as carbohydrate.
- Adults may be given 5 mg/kg/min and children 5-7 mg/kg/min. One of the recommendations is to give very little fat. In adults 4% and in children 2-3% of total energy requirement should be met with fat.
- Each unit must be able to prepare diet formula depending upon local feeding habits. These formulae should be designed in consultation with a dietitian.
- Whenever diet is prepared, one must see the proportion of carbohydrate and protein. One should see that the proteins are properly assimilated and they are used as building blocks not as a source of energy provider.
- Minimum of 100 calories are required for assimilation of 1 gm of nitrogen. Patient should be regularly weighed and patient must not be allowed to lose weight for more than 5%. If patient loses 20% of its original weight, the outcome of such patient is unfavorable.
- Attention should be given to timely measurement of serum albumin and electrolytes. These parameters should be kept to near normal level.
- Burns patients tend to develop low immunity both humeral and cellular; therefore immuno-modulators are given to these patients.
- A good protein diet containing Glutamine, Arginine and other micro-nutrients like vitamins, iron, Page 34 of 48 calcium, zinc, selenium, copper & intravenous immunoglobulins especially IgG & IgM given to burn patients has shown to improve their survival.
- Early we are able to close burn wounds, the rapid is the recovery of immune and other systemic problems.