Because of massive edema, patients are hugely swollen, occasionally doubling their original weight. But if they aren't adequately nourished their muscle mass can waste away. While better nutrition, early debridement, improved grafts, and artificial skin have boosted survival rates, new layers of complexity in burn wounds are emerging, according to interviews and to reports at the American Burn Association meeting here. Cytokines, especially interleukins 1 and 6 and tumor necrosis factor, may be key to many of the local and systemic effects. They're called the new frontier of burn therapy.
Fluid resuscitation is the first step in therapy.
Patients may get 20 to 30 liters the first day and need almost as much the second, says Dr. Bruce Greenstein, head of the Jacobi Hospital unit here that treated Shabazz. Some compare it to filling a sieve. At Cincinnati Shriners, a duodenal tube is inserted on admission for enteral feeding, based on the burn size, patient's age, and status. Dr. Gottschlich says if food does not get into the gut, its microvilli atrophy and GI infections are more likely. But despite careful nutrition, burned children lose lean body mass, becoming peripherally skinny and centrally fat.