Manual of Clinical Nutrition

Burns

Manual of Clinical Nutrition Management III- 7 Copyright © 2013 Compass Group, Inc.

30% TBSAB, use the following formulas, where BSA = Body Surface Area and BSAB = Body Surface Area
Burned (11):

Galveston infant 0 to 12 months 2,100 kcal/m^2 BSA + 1,000 kcal/m^2 BSAB

Revised Galveston 1 to 11 years 1,800 kcal/m^2 BSA + 1,300 kcal/m^2 BSAB

Galveston adolescent 12 to 18 years 1,500 kcal/m^2 BSA + 1,500 kcal/m^2 BSAB

The Curreri formula, which was proposed to calculate the energy needs of the burned adult, has been
modified for pediatric patients by using balance studies of weight in burned children (12). The Curreri junior
formula is designed for burns of less than 50% total body surface area. It typically overestimates energy
requirements in burns exceeding 50%.

Age 0 to 1 year: Basal kcal + 15 kcal x % Burn

Age 1 to 3 years: Basal kcal + 25 kcal x % Burn

Age 3 to 15 years: Basal kcal + 40 kcal x % Burn

Protein requirements: Protein needs of burn patients are directly related to the size and severity of the
burn. The increased protein demand is necessary to promote adequate wound healing and to replace
nitrogen losses through wound exudate and urine. Failure to meet heightened protein needs can yield
suboptimal clinical results in terms of wound healing and resistance to infection. Infants and children further
adapt to inadequate protein intake by curtailing growth of cells, conceivably sacrificing genetic growth
potential. Most sources currently suggest the following for adult burn patients using actual weight, unless
otherwise specified (1,3):
 Adults with TBSA < 10% 1.2 g/kg/day (1,3)
 Adults with TBSA > 10% 1. 5 g to 2.0 g/ kg/day (1, 3)
 Adults with large surface area burns may require higher protein intake of 3.0 to 4.0 g/kg/day (3)
 Adults (with BMI > 30) 2.0g/kg/IBW (3)
 Adults target 120 to 150 Non Protein Calorie:1 g nitrogen (9)

In addition, the following has been suggested in the literature:
Adults (1,13,14)

<10% TBSAB 1.2 to 1.5 g/kg of actual or ideal body weighta
10% to 15% TBSAB 1.5 to 2.0 g/kg of actual or ideal body weighta
15% to 35% TBSAB 2.0 to 2.5 g/kg of actual or ideal body weighta

35% TBSAB 23% to 25% of total energy
aConsider using ideal body weight when an actual weight cannot be evaluated or measured, or in cases of severe obesity in which protein
requirements may be overestimated if the actual body weight is used.

Children (10,15,16)

<1% TBSAB 3 to 4 g/kg

1% to 10% TBSAB 15% of total energy or non-protein calories to nitrogen ratio (NPC:N) of

150:1

>10% TBSAB 20% of total energy or NPC:N of 100:1

Assessment of Protein and Energy Intake: Nitrogen balance in adult patients using the standard equation
of nitrogen intake (g) – urinary urea nitrogen + 4 (for obligatory losses of skin, sweat, epithelial) is a
reasonable indicator of adequacy of protein and energy intake as long as normal renal status is maintained
and accurate intake and output of nitrogen is collected and analyzed (3). The clinician should realize daily
variances that cause protein breakdown such as surgery, infections and sepsis. During the first 7 weeks
postburn the adult patient’s nitrogen balance results should target an anabolic range +5 to +10 g/day (3).
Most likely, aggressive nutrition support (eg, enteral nutrition feedings) will be necessary to achieve this goal.
Over time as wound closure is achieved, protein needs can taper and a range of +2 to +4 is acceptable for a
wound < 5% open (3).