Burns: Nutritional Considerations

• Increased calorie requirements: Burn patients have an increased metabolic rate. As a result, their calorie needs may exceed 5,000 calories per day. Significant weight loss is preventable by nutritional support with increased calories. In some cases, tube feeding may be necessary, particularly in burns involving the face and in inhalation injuries.
  
  A high–protein, high–carbohydrate, low–fat diet is recommended.
  Low–fat diets may result in less muscle loss and more improvement in weight, fewer infections, and shortened hospitalization time. However, the benefit of a high–carbohydrate formula must be balanced with the risk for high blood sugar.
• Fluid needs: Because of the damaged skin barrier, significant water loss can occur. Patients with advanced burns require continuous intravenous fluids to maintain hydration.
• Vitamin supplements: Levels of the vitamins A and E and carotenoids (e.g., beta–carotene) may be low in burn patients. Further, vitamin D synthesis is impaired, which may result in poor bone mineral density. Consequently, supplementation with the recommended dietary allowance has been suggested for patients with significant burns.  
• Mineral supplements: Patients with major burns suffer deficiencies of various minerals, including zinc, selenium, and copper. In one study, the addition of mineral supplementation in hospitalized burn patients was associated with a significant decrease in the number of pneumonia infections and with a shorter hospital stay.