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Hypermetabolic response to burns 

Hypermetabolic response to burns
Chapter:
Hypermetabolic response to burns
Author(s):

David N. Herndon

, Celeste C. Finnerty

, and Rene Przkora

DOI:
10.1093/med/9780199699537.003.0004
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date: 29 March 2020

Large burns are one of the most disastrous injuries today. The survivor experiences a tremendous metabolic response that does not resolve with burn wound healing. This response is seen in patients with burns over more than 30% of the total body surface area (TBSA). Two phases are observed: the 'ebb' phase starts immediately after a burn, lasts for 2–3 days, and is characterized by a “shock state” with decreases in cardiac output and metabolism; the ‘flow’ phase starts approximately 5 days after a burn. This phase can last up to 3 years in paediatric patients with >30% TBSA. The flow phase is characterized by persistent hypermetabolic and inflammatory responses, leading to catabolism and loss of function. Early interventions, including excision and grafting of wounds, enteral feeding, treatment of infections, pharmacological interventions (eg. anabolic hormones, adrenergic receptor antagonists), and exercise, can successfully attenuate this deleterious response.

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