What is the physiology of burn injuries?

Updated: Jan 10, 2018
  • Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Tissue burn involves direct coagulation and microvascular reactions in the surrounding dermis that may result in extension of the injury. Large injuries are associated with a systemic response caused by a loss of the skin barrier, the release of vasoactive mediators from the wound, and subsequent infection. This results clinically in interstitial edema in distant organs and soft tissues, with an initial decrease in cardiac output and the metabolic rate. [24]

After successful resuscitation, a hypermetabolic response occurs, with near doubling of cardiac output and resting energy expenditure. Accelerated gluconeogenesis, insulin resistance, and increased protein catabolism accompany this response. Modification of this physiology through the administration of beta-adrenergic blockade, beta-adrenergic supplementation, nonsteroidal anti-inflammatory agents, recombinant growth hormone, androgenic steroids, and insulinlike growth factor 1 have been proposed to modify this physiology. Currently, data do not support the routine use of these therapies.

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