Support of the metabolic response to burn injury.
Severe burn causes metabolic disturbances that can last for a year after injury; persistent and profound catabolism hampers rehabilitative efforts and delays the meaningful return of individuals to society. The simplest, effective anabolic strategies for severe burn injuries are: early excision and grafting of the wound; prompt treatment of sepsis; maintenance of environmental temperature at 30-32 degrees C; continuous feeding of a high carbohydrate, high protein diet, preferably by the enteral route; and early institution of vigorous and aerobic resistive exercise programmes. To further keep erosion of lean body mass to a minimum, administration of anabolic agents, recombinant human growth hormone, insulin, oxandrolone, or anticatabolic drugs such as propranolol are alternative approaches. Exogenous continuous low-dose insulin infusion, beta blockade with propranolol, and use of the synthetic testosterone analogue oxandrolone are the most cost effective and least toxic pharmacological treatments to date.
Herndon
David N
DN
Shriners Hospital for Children, 815 Market Street, Galveston, TX 77550, USA. dherndon@utmb.edu
Tompkins
Ronald G
RG
D002056:Burns / Q000378:metabolism* / Q000628:therapy*; D004734:Energy Metabolism; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D018529:Nutritional Support; D010084:Oxidation-Reduction; D010101:Oxygen Consumption; D013696:Temperature
D006728:Hormones