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Restoring nitrogen balance after burn injury.

The metabolic response to burn injury is characterized by weight loss and marked protein wasting. This phenomenon is mediated hormonally, resulting in hypermetabolism. Energy expenditure increases linearly with the extent of burn injury, reaching a plateau of twice resting energy expenditure when 50% of the total body surface area is involved. It is therefore essential to minimize other factors that may further augment postburn catabolism. Occlusive dressings, a warm ambient environment, analgesics, and timely closure of the burn wound are all important therapeutic measures in this regard. Furthermore, it is imperative to institute early nutritional support in order to offset the negative metabolic effects of severe burn injury.