Manual of Clinical Nutrition

Burns

Manual of Clinical Nutrition Management III- 8 Copyright © 2013 Compass Group, Inc.

Calculate nitrogen balance from a 24-hour urine collection analyzed for urea urinary nitrogen (UUN):

Nitrogen balance = Nitrogen In (Intake analysis) – Nitrogen Out (see below)

Nitrogen out can be estimated using the following formula for children (13):

[(24-hour UUN collection  1.1a) + (1 g for stool losses) + (estimated wound nitrogen lossb)]

divided by

6.25 g of protein per gram of nitrogen (9) = estimated nitrogen losses (output) per day

arepresents obligatory losses (skin, sweat, epithelial)

bwound nitrogen (N) loss: ≤10% open wound = 0.02 g N/kg actual weight per day

11% to 30% open wound = 0.05 g N/kg actual weight per day

≥31% open wound = 0.12 g N/kg actual weight per day

Parenteral Nutrition
Carbohydrate (3,4,14,17)
Adults 3 to 4 mg/kg per minute parenteral glucose infusion or approximately 50 to 60% of total
energy requirements in critically ill burn patients (3,18). Insulin should be used to
maintain normoglycemia (3,19-20).
Children Initiate dextrose at 7 to 8 mg/kg per minute and advance as needed to maximum of 20%
dextrose solution.
Infants Initiate dextrose infusion at 5 mg/kg per minute and advance to 15 mg/kg per minute
over a 2-day period.

For all burn patients, carbohydrates should account for approximately 50% of total energy.

Fat (3,16,17)
Adults 10% to 30% of total energy in critical care with 2 % to 4% as essential fatty acids
to prevent deficiency (3)
Children >1 year 30% to 40% of total energy
Children <1 year Up to 50% of total energy

Percent TBSAB Feeding Approach
<20% (if not complicated by
facial injury, inhalation injury,
or preburn malnutrition)

High-energy, high-protein oral diet is generally sufficient.

20% Nocturnal tube feeding to supplement dietary intake during the day may
be adequate to meet needs; use nutrient intake analysis to ensure
adequate intake.

If feeding is to be given totally by nutrition support, the enteral route is preferred over total parenteral
nutrition (3). Starting an intragastric feeding immediately after the burn injury (6 to 24 hours) has been
shown to be safe and effective. Total parenteral nutrition should be reserved for only those patients with
prolonged alimentary tract dysfunction. Gastric ileus is common in centrally injured burn patients. For these
patients, a transpyloric feeding may be indicated.

Micronutrient Requirements (1, 3, 17)
Electrolytes Provide based on serum and urine data and fluid
needs.
Minerals DRI
Trace elements DRI
Minor burns (<20% TBSAB) in all children and adults
(3,17)

One multivitamin daily

Major burns (> 20% TBSAB) in children younger
than 3 years (3,17)

One multivitamin daily

Vitamin C 250 mg twice daily

Vitamin A 5,000 IU daily

Zinc sulfate 110 mg daily