Nutrition

Nutrition is particularly important in burns because of the hypermetabolism experienced with large burns. Our goal is always to start nutrition within 6-8 hours of admission.

Criteria for enteral nutrition (EN) support are as follows:

  • >20% TBSA second and third degree burns
  • ≥ 10% TBSA second and third degree burns and > 65 years of age
  • Severe inhalation injury requiring mechanical ventilation and/or other major injuries/trauma
  • BMI <18.5 kg/m2 and/or  unintentional weight loss of > 5% in 1 month or 7.5%  in 3   months with evidence of suboptimal intake, resulting in severe loss of subcutaneous fat and/or severe muscle wasting
  • Inadequate nutritional intake for > 1 week prior to admission or oral intake <50% for more than 5 days in hospitalized patients
  • BMI > 35 kg/m2 with > 10% third degree burn

All burn patients are started on Impact Peptide 1.5 and are advanced to 40 ml/h. Once RD assesses the patient for nutritional needs goal rate and goal volume will be established.

Volume Based EN infusion: Once patient is tolerating EN at goal rate, volume based infusion (which is a nurse driven protocol) to provide the goal volume per day is initiated. RN will monitor EN intake every 4 hours and titrate goal rate to meet goal volume for the 24 hour period. Maximum goal rate 150 mL/h.

Perioperative Nutrition Orders:

  • On OR days based on the time of surgery please make patient NPO 6 hours prior to OR time
  • Post OR, restart EN at 150 mL/h for the rest of the 24 hour period.  Tube feeds do not need to be “ramped” if they were already at goal!

Vitamin Mineral Supplementation:

  • MVI with minerals. Patients who are intubated and with TBSA > 20 % AquADEKS x 2 weeks
  • 500 mg Vitamin C bid
  • Zinc Sulfate 220 mg
  • Vitamin A 10,000 units x 2 weeks
  • Vitamin D 1000 Units daily or treated based on levels

Nutritional Labs:

  • Weekly Prealbumin and CRP
  • Weekly Zinc and Copper levels
  • Weekly LFTs on patients who are on Oxandrolone

Refeeding Syndrome

  • Monitor electrolytes daily
  • Hold EN advancement if electrolytes are not stable with replacement protocol
  • Add 100 mg Thiamine x 7 days