Internship Report Muhammad Muzahir

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Name:
Muhammad Muzahir
Reg. No.:
2012-ag-3946
Degree:
B.Sc. (Hons.) Human Nutrition & Dietetics
Host Institution:
Military Hospital Rawalpindi
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3
Medical Nutrition Therapy in Burn

Patient
Outline
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 Introduction to Burn
 Types & Assessment of Burn
 Stages of Burn
 Case Study
 M.N.T
 Caloric Requirements
 Diet Plan
 Overfeeding Syndrome
 Conclusion
Burn
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―A burn is an injury to the skin or other organic tissue

primarily caused by heat or due to radiation,
radioactivity, electricity, friction or contact with
chemicals.
Respiratory damage resulting from smoke inhalation,
are also considered to be burns.‖
(W.H.O.)
Global Scenario
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 Globally, burns are a serious public health problem.

 An estimated 2,65 000 deaths occur each year from fires alone, with
more deaths from scalds, electrical burns, and other forms of burns.
 Over 96% of fatal fire-related burns occur in low- and middle-
income countries due to less facilities.
 In addition to those who die, millions more are left with life long
disabilities often with resulting stigma and rejection.
(W.H.O.)
Types of Burn
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 Fire/flame (42%)
 Scald (31%)
 Hot object contact (9%)
 Electrical (4%)
 Chemical (3%)
 Other – radiation, skin disease, or unspecified/unknown etiology (6%)
Pathophysiology of Burns
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Assessment of Burn
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• There are three important criteria to asses the burn

 Burn Depth
 Total Body Surface area burn
 Involvement of sensitive areas( Face, Hands , Feet, Genitalia ,
Major Joints)
Stages of Burn
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FIRST SECOND THIRD
BURN DEPTH Epithelium Epithelium and top aspects Epithelium and dermis
of the dermis
WOUND TYPE No blisters; dry Moist, oozing blisters Leathery, dry, no elasticity
pink
CAUSES Sunburn, scald, Scalds, flash burns, Contact with flame, hot
flash flame chemicals surface, hot liquids, chemical,
electric
PAIN Painful, tender, Very painful Very little pain, or no pain
(SENSATION) and sore
HEALING TIME Two to five days; five to 21 days Deep: 21- Small areas may take months
peeling 35 days to heal
Case Study
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 A 13 years old girl (Rabia) admitted on 11-1-2016 in M.H
(originally burned 4 month back and treated in local hospital of
Mianwali) with deep flame burn (self inflicted with petrol)
 Height---159cm
 Weight—45kg
 BMI---17.80
 IBW---56
 ABW---50
 Burn Grade– III degree burn
 Firstly she was on parenteral feeding and her weight continuously

decreasing than we suggest tube feeding & oral diet plan for her:
Biochemical tests Values
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Test Value Normal Value
W.B.C 6.20 4---10x103/l
Hb. 8.3 12---15g/dl
Platelets 202 150—400x103/l
S. Urea 4.1 3.3—8.3mmol/l
ALT 80 37units/l
Na 140 136—145mmol/l
Medical Nutrition Therapy
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 Nutrition support is recognized as one of the most significant

aspects of care for the burned patient
 Weight loss is common complication in burn
 Feeding initiated (EN or PN) soon after resuscitation is complete
 Enteral feeding within 4 to 12 hours has been shown successful in
decreasing hyper catabolic response
Metabolic Changes in Burn Patient
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 Increased in rate of glucose production and use

 Increased in rate of lipolysis
 Increased protein catabolism and anabolism
 Increased energy expenditure in severe burns which exceeds that of
any other injury
Dietary Modifications
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 High protein, high caloric diet (including oral supplements)

 High protein, high caloric diet with supplemental enteral feeding
 Enteral feeding.
Patients with Larger Burn need enteral feedings
Macronutrients Requirements
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Carbohydrates
 50%-60% of total calories
Protein
 Should provide 20%-25% of total calories up to 1.5-3g/kg body
weight
Lipid
 Limit lipid 12%-15% of calories (excess fat weaken the immune
system)
Micronutrients Requirements
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DAILY DOSE
Vitamin B
Complex
Thiamine 10mg
Riboflavin 10mg
Niacin 200mg
Vitamin B6 20mg
Folate 2mg
Vitamin B12 20µg
Vitamin C 2g
Minerals
Selenium 100µg
Copper 2-3mg
Zinc 50mg
Manganese 25-50mg
Caloric Requirements
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 HARRIS BENEDICT EQUATION

BEE (kJ) = 2741 + (40 x kg Wt.) + (7.7 x cm Ht.) – (19.6 x age)
= 5710.5kj
=1425kcal
 EER = BEE x I.F
EER= 1425x2
=2855kcal
Protein
2x50
=100g/day
Diet Plan
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Time & Kcal Food Quantity Protein (g)
Breakfast Porridge with olive oil 160g + 5ml 28g
680 Egg 2
Milk 250ml
Bread with honey 2 Slice + 5g
Mid-Morning Aminoplasmal 10% 250ml 20g
250
Lunch Chicken/Mutton/Fish 140g (5oz) 40
535 Chapatti 1 or 2
Yoghurt + Salad
Evening Fruit(Apple , Banana) 3 small size ----
195
Dinner Beans 160g 20
430 Chapatti or Boil rice with coconut oil 1 or 1 small plate (160g)
Yoghurt + Salad
Bed Time Beneprotein + water 6 scoops+190ml 6g
250 Or
Milkshake 250ml
Factors affecting dietary intake
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 Nausea or vomiting
 Anorexia
 Pain
 Constipation/diarrhoea
 Procedures, e.g. change of dressing
 Frequent surgical intervention
Overfeeding Complications
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 Overfeeding in severely burned patients can lead to major

complications.
 Increased carbohydrates results in elevated respiratory quotients,
more fat synthesis, and increased CO2 elimination.
 Excess carbohydrate or fat can also lead to fat deposition in the liver.
 Excess protein replacement leads to elevations in blood urea nitrogen
(BUN), which could lead to acute renal failure, sepsis, and death
More Food Choices For Nutrients Intake
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Nutrients Best Sources
Protein 5 ounces of chicken breast, 1/2 cup of almonds, 1 cup of low-fat milk, 4 ounces of
salmon and 1 cup of black beans.
Carbohydrates Pick healthy sources of carbohydrates like whole grains, rice, beans, fruits and
vegetables
Fat Pick healthy, unsaturated fats like nuts, nut butters, avocados, seeds, olive oil and fish
oil
Zinc, iron & Choose Beef, spinach and nuts

Selenium
Vitamin A,D & Sweet potatoes, carrots, fortified milk, orange juice, Citrus fruits, berries and kiwi
C fruit
High Caloric Almonds and nuts are high calorie healthy foods, patient need after a severe burn
Conclusion
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Better Nutrition in Burn patient can

1:Minimize metabolic response by controlling:
 Environmental Temperature
 Maintaining pain and anxiety
 Maintaining fluid and electrolyte balance
 Covering wounds
2: Meet nutritional needs by:
 Provide adequate calories to prevent weight loss greater than 10%
 Provide adequate protein for positive nitrogen balance
 Provide vitamin and mineral supplements
Cont.….
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3:Prevent Curling ulcer by:

Providing enteral feeding
References
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 Agency for Clinical Innovation. 2011. Clinical Practice Guidelines of
Nutrition for Burn Patient Management. Agency for Clinical
Innovation. pp. 40
 Mahan, L. and Sylvia, K. 2008. Krause food and nutrition therapy.
12th Edit. Elsevier, PA. USA. pp. 1033-1038
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Internship Report Muhammad Muzahir

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1

Medical Nutrition Therapy in Burn

―A burn is an injury to the skin or other organic tissue

 Globally, burns are a serious public health problem.

• There are three important criteria to asses the burn

 Burn Grade– III degree burn

 Firstly she was on parenteral feeding and her weight continuously

Test Value Normal Value

W.B.C 6.20 4---10x103/l

Hb. 8.3 12---15g/dl

Platelets 202 150—400x103/l

S. Urea 4.1 3.3—8.3mmol/l

 Nutrition support is recognized as one of the most significant

 Increased in rate of glucose production and use

 High protein, high caloric diet (including oral supplements)

Vitamin B12 20µg

 HARRIS BENEDICT EQUATION

 Overfeeding in severely burned patients can lead to major

Zinc, iron & Choose Beef, spinach and nuts

Better Nutrition in Burn patient can

3:Prevent Curling ulcer by:

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