Deck 19: Nutrition for Burned Pediatric Patients

Question 1

What are the hallmark physiologic responses of the body during the EBB and FLOW response after a burn injury?

Answer 1

EBB: reduced plasma volume, shock, hypovolemia, low plasma insulin, reduced oxygen consumption, tissue hypoxia, decreased REE, decreased cardiac output, impaired glucose tolerance, decreased body temperature
FLOW: elevated catecholamines, glucagon, glucocorticoids, insulin levels, catabolism, hypermetabolism, mobilization of metabolic reserves, accelerated gluoconeogenesis, hyperglycemia increased 02 consumption, body temperature and cardiac output, increased urinary excretion of nitrogen, magnesium, phosphorous and potassium, immunosupporession
(adaptive FLOW phase): subsiding stress hormone levels, anabolism, restoration of endogenous protein stores, normoglycemia, wound healing

Question 2

What formula is used for fluid resuscitation in pediatric burn patients? What other parameters should be monitored to ensure hydration needs are being met?

Answer 2

Parkland formula-modified to include a factor for basal fluid needs and compensation for wound losses. Should be used in conjunction with assessment of patient's vital signs, blood pressure and urinary output to ensure hydration needs are being met.

Question 3

What are the drivers of the hypermetabolic response after a burn injury?

Answer 3

Elevated levels of circulation cytokines, catecholamines, glucagon, cortisol
Sleep pattern disturbances: inverse correlation with epinephrine and norepinephrine levels and rapid eye movement (REM) stage of sleep-possible neuroendocrine response to lack of sleep as contributor to hypermetabolism
Wound infection
Pain and anxiety

Question 4

List the ways to assess a pediatric burn patient's energy needs.

Question 5

Describe the metabolic dysfunction of carbohydrates, protein and fat after a burn injury.

Question 6

What are the common micronutrients supplemented after a burn injury?

Question 7

What is the role of Vitamin D after a burn injury and why is additional supplementation warranted?

Question 8

What are the perceived benefits of providing early enteral nutrition support?

Question 9

Name 3 indications for the use of parenteral nutrition support in pediatric burn patients.

Question 10

Name some of the components of a nutrition assessment and monitoring program for pediatric burn patients.