CASE TITLE
Energy and Protein Intake Accelerate Wound Healing, Maintain Positive Nitrogen Balance and Prevent Blood Infection in Burn Diabetic Patient
BACKGROUND
Burn injury causes a persistent hypermetabolic state as well as an increased rate of protein catabolism and anabolism. Thus, adequate energy and protein intake should be given to accelerate wound healing, maintain positive nitrogen balance and prevent blood infection.
CLIENT HISTORY
A 60 years old Indian Man diagnosed with alleged 2nd degree burn 8.5% over left forearm bilateral upper and lower limb. He had underlying Diabetes Mellitus, hypertension, and CVA with left hemiparesis. Re-referred to Dietitian on post trauma day 10 for nutrition support as patient having poor oral intake.
ASSESSMENT
BMI was normal. Biochemical findings showed low level of albumin, sodium, magnesium and phosphate. White blood cells counts were high and patient had poor glycemic control. Oral intake was 1120kcal while protein intake was 47g.
NUTRITION DIAGNOSIS
Inadequate protein intake related to increased nutrient needs (burn) as evidenced by current protein intake 47g as compared to requirement 138g(2.0g/kgBW)
OBJECTIVES & PRESCRIPTIONS
Objectives : To attain adequate energy and protein intake, good glycemic control, prevent infection and facilitate wound healing
Prescriptions: Energy = 2000kcal(Toronto Formula), Protein = 138g(NPC:N, 87:1), CHO = 250g(<5g/kgBW), Fat = 22% @ 49g(should not exceed 30% from requirement), Glutamine = 20.7g(0.3g/kg)
OUTCOME & FOLLOW UP
Follow up continued until post burn D17. Laboratory value shows an increasing trend of albumin(20 to 29mmol/L), WBC(18.1 to 5.3mmol/L), Magnesium, Sodium and Phosphate were normal, good glycemic control and no infection noted on wound. Oral intake improved from 1120kcal to 1964kcal, protein from 47g to 104g. Protein requirement was reduced to 1.5g/kg as wound getting better. Calorie remained same.
DISCUSSIONS
Prins(2008) also practiced a prescription of 1.5-2.0g/kg of protein to maintain positive nitrogen balance, prevent infections and accelerate wound healing in burn patient.
LEARNING POINTS
• High energy and protein requirement should be given to burn patient
• Protein intake is essential, since improved survival has been found with high-protein diets
• Calorie and protein remain elevated until wound healing is complete.
