affected children will have a protein requirement of approximately 2.5g/kg/day
with caloric needs close to 1.5 times the calculated basal metabolic rate.
Children suffering from major burns should receiving vitamin
supplementation in the form of a multivitamin, in addition to vitamin C, vitamin A
and zinc sulfate to ensure adequate wound healing. In select patients,
provision of adequate calories and nitrogen fails to arrest the hypermetabolism
prompting the use of pharmacologic adjuncts to aid in halting this
hypercatabolic state. One such adjunct is oxandrolone, a synthetic derivative
of testosterone, which has shown to increase protein synthesis and decrease
loss of lean body mass. Its use has been shown to be beneficial in expediting
recovery in children in both the acute and recovery burn phases.
Another useful agent in pediatric burns is propanolol, a nonselective
beta blocking agent. Beta blockade in severely burned children diminishes
supraphysiologic thermogenesis, tachycardia, myocardial oxygen demand and
resting energy expenditure. This decrease in the hypermetabolic response
lessens the deleterious effect of muscle catabolism.
VII. Cold Injuries
Exposure to cold temperatures can also lead to tissue injury, particularly
in the extremities. The extent of injury is dependent on the temperature and
duration of exposure. Management consists of rapid rewarming and
aggressive wound care with debridement of nonviable tissue to minimize
systemic effects. Debridement should not be done with the same immediacy