Medical Nutrition Therapy For Burn Patients

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Medical Nutrition Therapy For Burn Patients

• Michael Moore
• Concordia College
• Moorhead, MN

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Goals

• Able to recognize the types of burns
• Able to calculate energy and protein needs of
  burn patients
• Understand the bodys response to burns
• Understand the nutritional support for burn
  patients

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Defining Burns

• Bodily tissue injury resulting from exposure to
  heat, chemicals, electricity, or radiation
• Marked by varying degrees of skin destruction

http//www.merriam-webster.com/medlineplus/burns
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Epidemiology

• More that 1.1 million victims per year
• 4,500 fatalities per year
• More than 50 of burn patients treated in
  specialized burn centers

http//www.nih.gov/about/researchresultsforthepubl
ic/BurnsandTraumaticInjury.pdf
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Classification of Burn Injuries

• There are two ways to classify burns
• Depth of the wound
• Percentage of the body surface area that is
  affected

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Classification of Burn Injuries

• There are four types of depths of the wounds
• Superficial burn (formerly first degree)
• Injury to epidermis
• Normally heals within 5-7 days (ex. sunburn)
• Appears red because of the increased flow of
  blood
• Heals without scarring

http//www.burn-recovery.org/injuries.htm
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Classification of Burn Injuries

• 2. Partial thickness burn (formerly second
  degree)
• Involves destruction of the epidermis and dermis
• Produce open, weeping wounds
• Depending on size, may require skin grafts
• Usually leaves scars

http//www.burn-recovery.org/injuries.htm
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Classification of Burn Injuries

• 3. Full thickness burn (formerly third degree)
• All three layers of skin are destroyed
• Includes loss of hair follicles, sweat glands and
  the region where new skin cells are formed
• Requires skin grafts

http//www.burn-recovery.org/injuries.htm
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Classification of Burn Injuries

• 4. Fourth degree burns
• All layers of the skin is destroyed
• Burns extend through underlying tissues
• Involves destruction of muscle, organs, and bone
• Minimal pain

http//www.burn-recovery.org/injuries.htm
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Four Types of Burns

• Thermal Burns
• Contact Burns- result from contact with hot items
  or gasses
• Example flames
• Scalds- result from contact with hot liquids
• Example spilled liquids, bathwater
• Most common

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Four Types of Burns

• 2. Chemical Burns
• Causes
• Skin contact with chemicals
• Example acid or alkali, bleach
• Ingestion of chemicals

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Four Types of Burns

• 3. Electrical Burns
• Causes
• Result from contact with an electrical energy
  source
• Example electrocution, lightning strike
• Severity correlated to amount of voltage
• May lead to cardiac arrest

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Four Types of Burns

• 4. Radiation Burns
• Causes
• Result from contact with a source of radiation
  such as ultraviolet rays
• Example sunburn, use of tanning beds, high
  exposure to x-rays
• Can result in erythema

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Estimating Size of Burns

• Rule of Nines
• System to estimate the percentage of total skin
  that has been burned.
• Arm- each 9
• Head- 9
• Leg- each 18
• Chest- 18
• Back- 18
• Neck- 1
• Perineum- 1

http//emedicine.medscape.com/article/1277360-over
view
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Goals for Nutrition Support Include

• Maintain body mass
• Prevent specific nutrient deficiencies
• Improve wound healing
• Improve immunity
• Restore protein losses
• Avoid or minimize complications associated with
  enteral and parenteral nutrition
• Provide correct amount of nutrients and hydration

From Nutritional Balance is Disrupted...
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Estimation of Energy Requirements - Adult

• Harris Benedict Equation
• Female BEE 655.1 9.6W 1.9H - 4.7A
• Male Bee 66.5 13.8W 5H 6.8A
• BEE X Activity Factor X Injury Factor
• W weight in kg
• H height in cm
• A age in years
• Activity Factor
• 1.2 confined to bed
• 1.3 ambulatory
• Injury Factor
• 2.1 2.5 with severe burns

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Estimation of Energy Requirements Adult

• Ireton Jones Equation
• Spontaneously breathing (male or female)
• EEE (Estimated Energy Expenditure) 629 11(A)
  25(W) 609(O)
• Ventilated (male or female)
• EEE 1784 11(A) 5(W) 244(S) 239(T) 804
  (B)
• W Weight in kg
• A Age
• S Sex (male1, female2)
• T Trauma B Burns O Obesity (1 if present,
  0 if not present)

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Estimation of Energy Requirements - Child

• Galveston Formula
• Birth-4 yrs (2100 kcal x m2) (1000 kcal x m2
  x TBSA/100)
• 5-11 yrs (1800 kcal x m2) (1300 kcal x m2 x
  TBSA/100)
• 12-18 yrs (1500 kcal x m2) (1500 kcal x m2 x
  TBSA/100)

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Estimation of Energy Requirements

• Curreri Formula
• 24 kcal x kg usual body weight 40 kcal x TBSA
• Typical estimate for burn patients
• Adult 35-40 kcal/kg/day
• Child 40 (plus) kcal/kg/day