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Burns: modified metabolism and the nuances of nutrition therapy

02 April 2023
Volume 2 · Issue 1



To review the effects of burn injury on nutritional requirements and how this can best be supported in a healthcare setting.


A literature search for articles discussing nutrition and/or metabolism following burn injury was carried out. PubMed, Embase and Web of Science databases were searched using the key search terms ‘nutrition’ OR ‘metabolism’ AND ‘burn injury’ OR ‘burns’. There was no limitation on the year of publication.


A total of nine articles met the inclusion criteria, the contents of which are discussed in this manuscript.


Thermal injury elicits the greatest metabolic response, among all traumatic events, in critically ill patients. In order to ensure burn patients can meet the demands of their increased metabolic rate and energy expenditure, adequate nutritional support is essential. Burn injury results in a unique pathophysiology, involving alterations in endocrine, inflammatory, metabolic and immune pathways and nutritional support needed during the inpatient stay varies depending on burn severity and idiosyncratic patient physiologic parameters.

Thermal injuries are responsible for generating the greatest metabolic response of any disease process in critically ill patients.1 A number of alterations in inflammatory, immune and endocrine pathways are initiated upon injury.2 Immune cells are stimulated to secrete cytokines that can induce an unstable hypercatabolic state which, if left unregulated, may lead to multiple organ failure and systematic inflammatory response syndrome.3

Nutrition practice in burn injury requires a multifaceted approach aimed at providing metabolic support during a heightened inflammatory state, while accommodating surgical and medical needs of the patient. Nutritional assessment and determination of nutrient requirements is challenging, particularly given the metabolic disarray that frequently accompanies inflammation. Nutritional therapy requires careful decision making, regarding the safe use of enteral or parenteral nutrition and the aggressiveness of nutrient delivery given the severity of the patient’s illness and response to treatment.4,5 Nutritional support, defined as the provision of vital and ancillary nutrients to maintain or improve the patient’s nutritional status and permit wound healing,6 is essential in the management of burns.7 Treatment protocols should be evidence-based, originating from clinical and laboratory data.

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