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The Metabolic Basis of the Increase in Energy Expenditure in Severely Burned Patients
Author(s) -
Yu YoungMing,
Tompkins Ronald G.,
Ryan Colleen M.,
Young Ver R.
Publication year - 1999
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607199023003160
Subject(s) - gluconeogenesis , basal metabolic rate , energy expenditure , medicine , endocrinology , glycolysis , energy metabolism , resting energy expenditure , specific dynamic action , chemistry , adenosine triphosphate , metabolism
Background: Severe burn trauma is characterized by an elevated rate of whole‐body energy expenditure. Approach: In this short review, we have attempted to assess the metabolic characteristics of and basis for the persistent increase in energy expenditure during the flow phase of the injury. We consider some aspects of normal energy metabolism, including the contribution of the major adenosine triphosphate (ATP)‐consuming reactions to the standard or basal metabolic rate. Rate estimates are compiled from the literature for a number of these reactions in healthy adults and burned patients, and the values are related to the increased rates of whole‐body energy expenditure with burn injury. Results: Whole‐body protein synthesis, gluconeogene sis, urea production, and substrate cycles (total fatty acid and glycolytic‐gluconeogenic) account for approximately 22% 11%, 3%, 17%, and 4%, respectively, of the burn‐induced increase in total energy expenditure. Conclusions: These ATP consuming reactions, therefore, seem to explain approxi mately 57% of the increase in energy expenditure. The remainder of the increase may be due, in large part, to altered Na + ‐K + ‐ATPase activity and increased proton leak age across the mitochondrial membrane. (Journal of Paren teral and Enteral Nutrition 23: 160–168, 1999)