Nutritional Management in Burn Patients

Introduction

Nutritional therapy is one of the essential steps for healing acute burns. Appropriate nutritional management of patients helps ensure the treatment's optimal outcome. After the burn, the optimal energy requirement of the body is increased. Even if the burn area is small, it requires a high protein and high-calorie diet to fulfill the body's energy requirement. There is a significant rearrangement of the body's metabolism after the burn injury. There is a persistent hypermetabolic state and increases in catabolism which causes an increased energy requirement in the body. If the proper energy requirement is not fulfilled after the acute burn injury, it may result in susceptibility to infection, impaired wound healing, organ dysfunction, and septicemia. Therefore, nutritional therapy is crucial for proper healing in burn victims.

What Is Burn?

The skin helps in temperature regulation and fluid body maintenance. The ability to maintain body fluid is disrupted in skin injuries due to the burn. Burn is defined as tissue damage caused by thermal change due to exposure to heat radiation and electrical and chemical contact. It can cause minor medical problems to life-threatening situations. In addition, it can cause severe damage to the surface of the skin. Human skin can withstand a temperature of 107 to 110 degrees Fahrenheit. Temperatures higher than 110 degrees Fahrenheit can cause skin burning and tissue damage.

What Are the Kinds of Burns?

Listed below are the various type of burns:

• Mild Burn - It is also known as a first-degree burn. It involves only the epidermis surface of the skin. There is minimal tissue damage. Pain, inflammation, and erythema (redness) are seen. Scar formation is absent.

• Superficial Burn - It is also known as a second-degree burn. It involves the entire epidermis of the skin. Vesicles and blisters form as a result. In addition, nerve endings are exposed due to their tenderness. It heals in around two weeks.

• Midlevel to Deep Burn - It is also known as the second-degree deep burn. The injury occurs due to deep structure, and dermal appendages are injured.

• Full-Thickness Burn - It is also known as third-degree burn. The entire epidermis and dermis are involved. There is extensive fluid loss, and metabolic defects are seen.

What Is the Nutritional Management of Burn Patients?

Proper nutrition is essential for the healing process. Adequate diet and nutrition help in reducing the loss of lean body mass. The dietitian should assess a patient's dietary requirements to determine the nutrition intervention. There should be early commencement of the feeding. If there is a requirement for aggressive nutritional support, it should be followed as early as possible.

1. Goals of Nutritional Management in Burn Patients

• To improve and promote optimal wound healing in the patient.

• To promote the rapid recovery of burn injury.

• To maintain the normal nutritional status of the patient.

• To minimize metabolic disturbance during the treatment procedure.

2. Objectives of Nutritional Management in Burn Patients.

• To provide the proper nutrition through the eternal route eighteen hours post burn.

• To reduce mass body damage.

• To reduce the signs and symptoms of micronutrients.

• To minimize hyperglycemia.

• To minimize hypertriglyceridemia.

3 . Phases of Nutritional Management in Burn Patients:

• Ebb Phase - It persists during the shock period. It is present in the first twenty hours after the burn. After that, the patient responds to fluid resuscitation.

• Recovery phases - It is also known as the flow or resuscitation phase. There is a gradual increase in cardiac output and heart rate Temperature, and oxygen consumption is also increased in this phase. A high-protein diet, whole grains, vegetables, and low-fat dairy are advised.

• Anabolic Phase - It is also known as the hypermetabolic and hyperdynamic phases. It is seen after fourteen days of injury. The wound healing starts in this phase, and the skin recedes to normal. A high-calorie diet is indicated during this phase.

What Are the Dietary Requirements of Burned Patients?

The primary goal of a diet and nutrition plan in burned patients is to fulfill the dietary requirements. Listed below is the dietary plan of the burned patient:

• Carbohydrate - It is the most favored source of energy gain in the burned patient. In severely burned patients, seven grams per kilogram of body weight carbohydrate is required.

• Protein - There is a higher protein requirement in unburned patients due to increased urea production. Burn patients should consume 1.5 to 2 grams of protein per kilogram of body weight a day.

• Fat - It helps in preventing fatty acid deficiency in the person. Lipids' utilization in an individual's body is decreased due to the suppression of lipolysis after a burn. Therefore, fats should be given in body ratio, not more than 15 percent energy coming from lipids.

What Is Burn Recovery Diet?

A burn recovery diet provides energy and micronutrients in the body. As the burn increases the body's metabolic rate, more energy is required. The amount of nutrition for the healing depends upon the surface area of the burned skin. Listed below are the essential constituents of the burn recovery diet.

• Protein - For proper body healing, high protein intake is advised. The protein provides extra energy, essential for healing after the burn. Protein also helps in rebuilding the lost muscles.

• Carbohydrates - Carbohydrates help in the burn recovery of the patient. Carbohydrates form the bulk of nutrition. The wounds require glucose for healing purposes. Carbohydrates help the protein in the rebuilding of the muscles. It acts as fuel for energy.

• Fat - It is essential to a burn recovery diet as it provides high calories. It helps in reducing the damage to lean body mass.

What Should Be the Diet Plan Followed after Healing of Burn Injury?

Listed below is the diet that should be followed after wound healing:

1. Breakfast

   • Omelet.

   • Cheese with toast.

   • Scrambled eggs with toast.

   • Yogurt.

   • Cereal.

   • Toast with nut butter.

2. Lunch

   • Cottage pie.

   • Jacket potato with cheese and beans.

   • Meatball and spaghetti.

   • Tuna pasta bake.

3. Evening Meal

   • Steak and chips.

   • Baked salmon.

   • Boiled potatoes.

   • Broccoli.

   • Lamb with mashed potatoes.

   • Cheese potatoes.

   • Mexican beans.

Conclusion

Burn injury causes metabolic alteration in individuals, which can persist for a prolonged time. Due to the prolonged hypermetabolic state and the hypercatabolic reaction seen in burned patients, nutritional therapy is essential for the proper outcome of the patient. Therefore, nutritionists should evaluate the dietary requirement of the patient along with the undergoing treatment. The diet should be adjusted according to the body's requirements for energy. An adequate diet reduces the damage to lean body mass and helps in proper healing. Therefore, ensuring proper diet, nutrition, and treatment strategies is essential.