Metabolic Support
Nutrition, pharmacology, and metabolism
Severe burns drive sustained catabolism and a fall in anabolic hormones, including profound hypogonadism. Anabolic pharmacotherapy counters lean-mass loss. Oxandrolone, an oral testosterone analog, is best-evidenced; meta-analyses show reduced weight loss, fewer operations, and…
Propranolol, a nonselective beta-1/beta-2 antagonist, is used after severe burns to blunt the catecholamine-driven hypermetabolic response. Titrated to a 15-20% reduction in heart rate, it lowers cardiac work and resting energy expenditure, reverses muscle-protein catabolism…
Nutrition support in major burns counters a hypermetabolic, catabolic state. Enteral feeding is the route of choice, usually started within the first 24 hours, preserving gut integrity and blunting hypermetabolism. Energy targets are best set by indirect calorimetry, not…
Severe burns in children drive a catecholamine-mediated hypermetabolic response that elevates resting energy expenditure, drives muscle catabolism, and persists for up to two years. Management rests on three pillars: feed early and enterally to measured rather than…
Severe burn injury triggers the most extreme hypermetabolic and catabolic response of any critical illness, persisting at least 9 to 12 months after wound closure. Management couples early enteral nutrition and indirect-calorimetry-guided feeding with pharmacologic modulators…
- Burn energy expenditure and hypermetabolic physiology
The hypermetabolic response is the catecholamine-, cortisol-, and glucagon-driven surge in energy expenditure and whole-body catabolism that follows a major burn. It runs to twice-normal metabolic…
- Glycemic control, insulin therapy, and insulin resistance in burn patients
Severe burns drive a counter-regulatory hypermetabolic state that produces stress hyperglycemia and post-receptor insulin resistance, even in patients without diabetes. Hyperglycemia and high…