Title:The Hypermetabolic Response to Burns and its Treatment: A Literature
Review
Volume: 19
Issue: 7
Author(s): Madeline Houschyar*, Mimi R. Borrelli, Christian Tapking, Behrus Puladi, Mark Ooms, Zeshaan N. Maan, Clifford C. Sheckter, Susanne Rein, Georg Reumuth, Kristian Weissenberg, Constantin Weil, Dominik Duscher, Dominik Pförringer, Frank Siemers, Björn Behr, Marcus Lehnhardt and Khosrow S. Houschyar
Affiliation:
- Institute of Agricultural and Nutrition Sciences, Martin Luther University of Halle-Wittenberg, Halle, Germany
Keywords:
Burn, hypermetabolism, catabolism, pharmacological treatment, hypermetabolic response, recombinant human growth hormone (rhGH).
Abstract: Major burn injuries provoke a profound stress response marked by extreme hypermetabolism
and impaired immune function. The physiological alterations to glucose, protein and
lipid metabolism can be detected even years after the inciting burns injury and when untreated
can lead to profound wasting, fatty liver, and even death. Therapeutic strategies which target these
physiological disturbances are of paramount importance. Treating burn injuries begins with
active cooling, to minimize loss of heat and water, and nutrition, to counteract the extensive catabolism.
Providers should follow the strict guidelines published to ensure caloric requirements
are met in adult and pediatric patients, with supplementation as indicated. Several pharmacotherapies
have proven beneficial in helping to counteract and reverse these physiological changes by
lowering insulin resistance, slowing catabolism, and minimizing loss of lean body mass. The
most promising drugs include anabolic agents such as insulin, recombinant human growth hormone
(rhGH), insulin-like growth factor 1 (IGF-1), metformin, beta-blockers, oxandrolone, and
fenofibrate. Surgery is a necessary adjunct, either in the acute phase to debride compromised soft
tissue and prevent compartment syndromes, but also in the chronic setting to release contractures
and fibrotic strictures which may impair function. This narrative literature review provides a
synopsis of our understanding of the hypermetabolic response to burn injury and discusses the
different treatment options aiming to control postburn hypermetabolism and ultimately improve
patient outcomes.
