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The Metabolic Basis of the Increase in Energy Expenditure in Severely Burned Patients

Shriners Burns Hospital and Trauma Services, Massachusetts General Hospital, Boston

Ronald G. Tompkins, MD, ScD

Shriners Burns Hospital and Trauma Services, Massachusetts General Hospital, Boston

Colleen M. Ryan, MD

Shriners Burns Hospital and Trauma Services, Massachusetts General Hospital, Boston

Vernon R. Young, PhD, DSc

Shriners Burns Hospital and Trauma Services, Massachusetts General Hospital, Boston, Laboratory of Human Nutrition, Massachusetts Institute of Technology, Cambridge

Background: Severe burn trauma is characterized by an elevated rate of whole-body energy expenditure. Approach: In this short review, we have attempted to assess the metabolic characteristics of and basis for the persistent increase in energy expenditure during the flow phase of the injury. We consider some aspects of normal energy metabolism, including the contribution of the major adenosine triphosphate (ATP)-consuming reactions to the standard or basal metabolic rate. Rate estimates are compiled from the literature for a number of these reactions in healthy adults and burned patients, and the values are related to the increased rates of whole-body energy expenditure with burn injury. Results: Whole-body protein synthesis, gluconeogene sis, urea production, and substrate cycles (total fatty acid and glycolytic-gluconeogenic) account for approximately 22% 11%, 3%, 17%, and 4%, respectively, of the burn-induced increase in total energy expenditure. Conclusions: These ATP consuming reactions, therefore, seem to explain approxi mately 57% of the increase in energy expenditure. The remainder of the increase may be due, in large part, to altered Na⁺-K ⁺-ATPase activity and increased proton leak age across the mitochondrial membrane. (Journal of Paren teral and Enteral Nutrition 23:160-168, 1999)

Journal of Parenteral and Enteral Nutrition, Vol. 23, No. 3, 160-168 (1999)
DOI: 10.1177/0148607199023003160


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