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NUTRITION FOR CRITICALLY ILL: BURNS
Nutritional assessment of the critically ill patient and provision of adequate nutritional support are essential parts of critical care. Protein energy malnutrition is common not only in childhood but also in hospitalized patients. Very often, the only source of nutrition in critically ill patients is 5% glucose drip providing 100 kcal per bottle of 500 ml. The downward trend of nutritional status during hospitalization is further associated with increased morbidity and mortality including the lengthened hospital stay.
Hypermetabolism is a characteristic response to severe burn, which lasts up to one year after injury. Hypermetabolism can be reduced by nutritional treatments that include enteral feeding, high protein, high carbohydrate, and high calorie diet supplemented with n-3 fatty acids, arginine, glutamine, calcium and some vitamins. Early excision, prevention of infection, pain and anxiety also help in hypemetabolism.
After major surgery, trauma and burns, the healing of wounds is greatly influenced by nutritional status. There are many immune - entrancing enteral preparations known as nutraceuticals, which can be added on to improve nutritional status.
The basal calorie requirements of the patients may be estimated using Harris-Benedict equation for basal energy expenditure (BEE) - Energy expended by a normal person taking nothing by mouth, lying in bed. Correction factors are to be used for patients who have stress because of fever, trauma or infection.
Harris-Benedict Formulas for Basal Energy Expenditure (BEE)/Basal Metabolic Rate (BMR)
For women:
BEE =655 + (9.6 x W) + (1.7 x H)-(4.7 x A)
For men:
BEE =66 + (13.7 x W) + (5 x HM6.8 x A)
W = weight in kg
H = height in cm
A = age in years
*7/356/5*
GENERAL HEALTH
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