Postburn hypermetabolism has been shown to respond to a low-fat, high-protein enteral diet with fewer wound complications and a lower overall morbidity. Conversely, parenteral nutrition has consistently been linked to increased mortality in the burn patient. Burn wounds almost exclusively utilize glucose. This, coupled with the increased overall glucose requirements that come with thermal injury, means that glucose supply must be either increased in the diet or come from the catabolism of other tissues. For this reason, carbohydrates should serve as the major nonprotein source of nutrition. Doing so ensures not only that the wound will be better supplied with energy, but also that the rest of the body operates without quite so severe a demand for
gluconeogenic substrates, and so protein stores can be preserved. If a patient is poorly fed, the end result of this demand in such a patient has an energy deficit that has been shown to develop very early postburn. Hence, early and aggressive feedings are recommended. They have been shown to positively affect protein requirements, energy deficiency, and insulin secretion. Because hyperglycemia and protein malnutrition are well known for their detrimental effects on wound healing, it seems reasonable to assume that increased insulin and a decreased need for endogenous gluconeogenic substrates provide a benefit. Ideal energy balance is met with 5 mg/kg/min of glucose.