Therapeutic Approaches

to Combatting
Hypermetabolism
in
Nazihah Bakhtyar,
Thibacg Sivayoganathan
Severe
Burn Injuries
and Marc G Jeschke
Journal of Intensive & Critical
Care 2015, 1:1.

INTRODUCTION
Every year, patients with burn injuries account for
approximately 500,000 hospital emergency department
visits in the United States.
While most burn injuries are minor, 40,000
hospitalizations related to severe burn injuries occur
annually.
The complex pathophysiologic response of
hypermetabolism plays a central role for the acute
and long term outcomes in severely burned patients.
Burns encompassing greater than 20% total body surface
area (TBSA) are characterized by stress, insulin
resistance, hyperglycemia, lipolysis and catabolism.

OBJECTIVE
The objective of this review is to discuss
landmark studies in the field of
hypermetabolism postburn with regards to
the current best practice for efficacious burn
care and to investigate the pros and cons of
those treatments.

HYPERMETABOLISM POST BURNS

Glucose metabolism
The increase in glucose production is the
response to battle the elevated energy demands
post burn injury, and to maintain whole body
homeostasis.
Insulin resistance develops post-burn.

Protein metabolism
Muscle wasting and a decrease in lean body
mass (LBM) up to 25%.

Lipid metabolism
Burn injury promotes lipolysis.

NON PHARMACOLOGICAL
INTERVENTIONS
Wound excision and closure

Early excision and closure of the burn wound

post burn injury is extremely important in
alleviating the hypermetabolic response and
improving mortality and morbidity.

Nutrition
Nutrition is crucial in supplying the energy
supply required for wound recovery, and for the
attenuation of hypermetabolism and protein
catabolism.

Thermoregulation
Increasing ambient temperatures reduces
resting energy expenditure and attenuates the
effectsof the hypermetabolic response.

Exercise
Exercise is important to consider in rehabilitation
regimens to improve lean body mass, muscle
strength and general patient outcome.

PHARMACOLOGICAL INTERVENTIONS
Insulin
Studies reported improved survival and decreased morbidity by
maintaining blood glucose levels at or less than 110 mg/dL through the
use of intensive insulin regimens.
Recombinant human growth hormone
Growth hormone improves nitrogen balance and decrease weight loss in
hypermetabolic patients following thermal injury.
Metformin
Metformin is reported to inhibit gluconeogenesis and augment
peripheral insulin sensitivity.
Propanolol
Blocking b-adrenergic stimulation after severe burns decreases
supraphysiologic thermogenesis, tachycardia, cardiac work, resting energy
expenditure.
Oxandrolone
Combat the effects of protein catabolism.

CONCLUSIONS
A severe burn is a devastating injury that affects almost
every organ system, leading to morbidity and mortality,
and is accompanied by a hallmark hypermetabolic
response which persists for 1 to 2 years after the initial
burn injury
Treating post burn hypermetabolism is of high
importance for both the acute stage and rehabilitative
stage of the patient.
Non-pharmacological therapies consist of wound
excision and closure, nutrition, thermoregulation,
exercise.
Non-pharmacological by themselves are often times not
enough to alleviate the hypermetabolic condition and
pharmacological interventions are necessary.