Nutritional evaluation and energy expenditure in burn patients

According to this limited time I am going to describe a lot of nutritional risks in burn patients, soI prefer to point to the most important points:A. Hyper metabolic ResponseAbout catabolism of protein, 20% of which can be lost 2 weeks post burn. This is caused by increase in cortisol secretion, and mostly affects skeletal muscles and Specific amino acids. In this stage nutritional program and diet is very important. In gluconeogenesis greater use of CHO as energy source (Wolf, 2008), Caused step by step in this order:1. Increase glycogenolysis2. Cortisol secretion3. Increase catabolism of protein which caused by increase epinephrine & norepinephrine. We have to prepare the source of energy (CHO) fortified by vitamin B groups. B-Lipolysis:Fat oxidation may be normal in these patients, to obtain increased energy needs, release of free fatty acids at an abnormally large rate. In this situation malnutrition may be observed and increased risk of RFS (Refeeding syndrome).Immunodeficiency, increased risk of infection and sepsis, increased systemic energy expenditure, increased nutrient needs, Impaired wound healing, Insulin resistance, evaluating nutritional risk and Energy expenditure. I will try to explain some these items in limiting time that I will have.