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Cited by 149Burn Injury Management and OutcomesClinical Nutrition and GastroenterologyWound Healing and Treatments

The metabolic effects of thermal injury

Tredget, Edward E., Yu, Yong Ming·1992·World Journal of Surgery
DOI 10.1007/bf02067117
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Abstract

Major thermal injury is associated with extreme hypermetabolism and catabolism as the principal metabolic manifestations encountered following successful resuscitation from the shock phase of the burn injury. Substrate and hormonal measurements, indirect calorimetry, and nitrogen balance are biochemical metabolic parameters which are useful and more readily available biochemical parameters worthy of serial assessment for the metabolic management of burn patients. However, the application of stable isotopes with gas chromatography/mass spectroscopy and more recently, new immunoassays for growth factors and cytokines has increased our understanding of the metabolic manifestations of severe trauma. The metabolic response to injury in burn patients is biphasic wherein the initial ebb phase is followed by a hypermetabolic and catabolic flow phase of injury. The increased oxygen consumption/metabolic rate is in part fuelled by evaporative heat loss from wounds of trauma victims, but likely also by a direct central effect of inflammation upon the hypothalamus. Although carbohydrates in the form of glucose appear to be an important fuel source following injury, a maximum of 5–6 mg/kg/min only is beneficial. Burn patients have accelerated gluconeogenesis, glucose oxidation, and plasma clearance of glucose. Additionally, considerable futile cycling of carbohydrate intermediates occurs which includes anaerobic lactate metabolism and Cori cycle activity arising from wound metabolism of glucose and other substrates. Similarly, accelerated lipolysis and futile fatty acid cycling occurs following burn injury. However, recent evidence suggests that lipids in the diet of burned and other injured patients serve not only as an energy source, but also as an important immunomodulator of prostaglandin metabolism and other immune responses. Amino acid metabolism in burn patients is characterized by increased oxidation, urea synthesis, and protein breakdown which is prolonged and difficult to reduce with current nutritional therapy. However, the current goal of nutritional support is to optimize protein synthesis. Specific unique requirements may exist for supplemental glutamine and arginine following burn injury but further research is needed before enhanced branched chain amino acids supplements can be recommended for burn patients. Recent research investigations have revealed the importance of enteral feeding to enhance mucosal defense against gut bacteria and endotoxin. Similarly, research has demonstrated that many of the metabolic perturbations of burns and sepsis may be due, at least in part, to inflammatory cytokines. Investigation of their pathogenesis and mechanism of action both at a tissue and a cellular level offer important prospects for improved understanding and therapeutic control of the metabolic disorders of burn patients.

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Crossref · 10.1007/bf02067117

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  • Generation of the Cori cycle between lactate-producing inflamed tissue and glucose-producing liver, involving gluconeogenesis, needs five molecules of water to reactivate one molecule of lactate.

    “the generation of the Cori cycle between the lactate-producing inflamed tissue and the glucose-producing liver [33], involving gluconeogenesis, needs five molecules of water to reactivate one molecule of lactate (Fig. 1, red lines with arrows) [31].”

    From Evolutionary medicine and chronic inflammatory state—known and new concepts in pathophysiology (2012) · cites this paper as [33]

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Authors
Tredget, E. E., & Yu, Y. M.
Affiliations
University of Alberta Hospital (CA)
ORCID
Yu, Yong Ming
Venue
World Journal of Surgery
Publisher
Wiley
Published
1992-01
Volume
16
Issue
1
Pages
68-79
ISSN
  • 0364-2313 (ISSN-L)
  • 1432-2323
DOI
10.1007/bf02067117
OpenAlex
W1967379671
Cited by
149
References
178
Citations by year
2026: 1 · 2025: 4 · 2024: 1 · 2023: 16 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 7 · 2017: 4 · 2016: 3 · 2015: 8 · 2014: 5 · 2013: 8 · 2012: 9
FWCI
0.71
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • World Journal of Surgery (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of General Medical Sciences
Topics
  • Health Sciences › Medicine › Epidemiology › Burn Injury Management and Outcomes
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
Keywords
burns, hypermetabolism, catabolism, oxygen consumption, gluconeogenesis, Cori cycle, lipolysis, amino acid metabolism, protein degradation, nutritional support, glutamine, L-arginine, branched-chain amino acids, enteral nutrition, cytokines, inflammation, sepsis, prostaglandins, immunomodulation
MeSH terms
Amino Acids, Branched-Chain, Animals, Arginine, Burns, Digestive System, Fatty Acids, Glucose, Glutamine, Humans, Inflammation, Nutritional Physiological Phenomena, Proteins

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