Abstract
Burn patients develop a number of physiologic alterations among which is a markedly increased metabolic rate Other metabolic changes include an increased rate of glucose production and utilization, a decreased rate of lipid metabolism, and an increased rate of both protein catabolism and anabolism. These alterations can effect other physiologic parameters, including immune function. They necessitate administration of large quantities of calories and protein to achieve positive nitrogen balance. The physiologic derangements leading to the hypermetabolism and the methods for supplying the nutritional needs are discussed in this review.
Résumé
Un hypermétabolisme important est l'une des perturbations caractéristiques qui surviennent chez le brûlé. Des troubles métaboliques associent une augmentation de la production et de l'utilisation du glucose, une diminution du métabolisme lipidique et une augmentation à la fois du catabolisme et de l'anabolisme des protéines. D'autres fonctions physiologiques peuvent être atteintes comme la réponse immune. Ces troubles nécessitent un apport massif protéino-calorique pour positiviser le bilan azoté. Les perturbations physiologiques de l'hypermétabolisme et les méthodes pour évaluer les besoins nutritionnels sont discutées dans cet article.
Resumen
Los pacientes quemados desarrollan una variedad de alteraciones fisiológicas, entre las cuales está un marcado incremento de la tasa metabólica. Otras alteraciones metabólicas incluyen un aumento en las tasas de producción y utilización de glucosa, una disminución en la tasa del metabolismo de los lípidos y un aumento en las tasas tanto de catabolismo como de anabolismo proteicos. Tales alteraciones pueden afectar otros parámetros fisiológicos, incluyendo la función inmunitaria. Los pacientes requieren la administración de grandes cantidades de calorías y de proteína para lograr balance positivo de nitrógeno. Para optimizar las posibilidades de obtener balance positivo de nitrógeno se debe utilizar una de las fórmulas para estimar los requerimientos calóricos y realizar frecuentes determinaciones metabólicas. Se debe iniciar alimentación enteral dentro de las primeras 48 horas de ocurrida la quemadura, utilizando tubos de alimentación hasta cuando los pacientes puedan tomar adecuados volumenes de alimentos por vía oral. Se debe evitar la nutrición parenteral. La dieta debe contener aproximadamente 50% de las calorías como carbohidrato, 20–25% como proteína y 25–30% como grasa. La proteina debe contener suplementación de arginina hasta aproximadamente el 2% de las calorías. La suplementación con glutamina y aminoácidos racémicos es de eficacia aún no determinada.
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Waymack, J.P., Herndon, D.N. Nutritional support of the burned patient. World J. Surg. 16, 80–86 (1992). https://doi.org/10.1007/BF02067118
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DOI: https://doi.org/10.1007/BF02067118