Severe burn injury is followed by a profound hypermetabolic response that persists up to 2 years after injury. It is mediated by up to 50-fold elevations in plasma catecholamines, cortisol, and glucagon that lead to whole-body catabolism, elevated resting energy expenditures, and multiorgan dysfunction. Modulation of the response by early excision and grafting of burn wounds, thermoregulation, control of infection, early and continuous enteral nutrition, and pharmacologic treatments aimed at mitigating physiologic derangements have markedly decreased morbidity.
Key points
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Severe burn injury results in a significant and persistent hypermetabolic response.
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The hypermetabolic, hypercatabolic response is mediated by catecholamines, glucagon, and cortisol.
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Patients have supraphysiologic metabolic rates, heart rates, and full-body catabolism that persist for years postburn.
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There are multiple pharmacologic and nonpharmacologic modalities that help mitigate the postburn response and prevent physiologic exhaustion.
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