Nutritional Support after Thermal Burns

 

First, the BEE is calculated for the patient (see Chapter 12):

 

BEE in a man =

= 66.473 + (13.752 * (weight)) + (5.003 * (height)) - (6.755 * (age))

 

BEE in a woman =

= 655.096 + (9.563 * (weight)) + (1.85 * (height)) - (4.676 * (age))

 

where:

• BEE is expressed in kcal per 24 hours

• weight is in kilograms

• height is in centimeters

• age is in years

 

If the patient is obese (greater than 125% ideal body weight), then an adjustment for the weight needs to be made, since fat is metabolically inactive. The weight should be adjusted as follows:

 

adjusted body weight =

= (ideal body weight) + (0.025 * ((actual body weight) - (ideal body weight)))

 

Second, adjustments to the BEE is made, based on the severity of the burn.

%BSA as 2nd & 3rd degree	Burn Category	BEE	g protein per kg weight	carbohydrate (times normal)
< 15%	mild	1.1-1.5
15-30%	moderate	1.5	1.5	1.5-2.0
31-45%	major	1.5-1.8	1.5-2.0	2.0-2.5
> 46%	massive	1.8-2.2	2.0-2.3	3.0

 

Third, the initial protein requirements in grams is determined based on the patient's body weight, according to the table above. The number of grams times the caloric value of protein (4 calories per gram) is calculated.

 

Fourth, the amount of carbohydrate is determined. This should be about 60% of the total caloric need. However, this should not exceed 2100 calories per day, due to the metabolic consequences of high carbohydrate intake.

 

Fifth, the amount of fat is determined. This should not exceed 20-25% of the total caloric need.

 

Finally, if the initial protein, total carbohydrate and total fat calories is insufficient to meet the BEE needs, additional protein is given to make up the difference.