Nutritional management of the burn patient
The incidence of burn injuries is on the increase in Africa due to migration to urban areas and the development of slum areas, but there is a paucity of such data on the African continent. The South African Medical Research Council has indicated that 3.2% of the South African population is burned annually, with 50% of individuals who suffer burns being younger than 20 years. The Red Cross Children’s Hospital admits 650 to 900 children with burn injuries annually. Burn injury, the most severe type of injury from a metabolic point of view, is characterised by the most profound alterations in basal metabolic rate and urinary nitrogen excretion. In addition, requirements for and/or metabolism of macro- and micronutrients are altered or increased. The major improvement in burn survival can be attributed to many factors, one being the development and implementation of improved methods of nutritional support that optimise host defences, enhance wound healing and support the metabolic response to stress. The greatest threats to survival from burns are still infection/sepsis, with burn wound sepsis and nosocomial pneumonia, including ventilatorassociated pneumonia (VAP), being the leading causes of death.2,3 Effective medical nutrition therapy in patients with burn injuries requires an understanding of the physiologic and metabolic alterations that accompany the burn injury, alterations in the immune system and the role of reactive oxygen species (ROS).