Burn

Description

Burns, of which over two million are reported annually in the United States, are a result of denatured protein ending in tissue injury.

The extent of injury relates to what agent caused the burn and the duration and intensity of action. Minor burns involve local dilation and increased permeability of capillaries resulting in edema. More severe burns can be life threatening; a burn which affects more than 20% of the body is considered as such.

Burns are classified according to the following criteria:

First degree burns (ie. sunburns)
damage is limited to the epidermis

Second degree burns
damage extends to the dermis

Third degree burns
involve destruction of skin and can extend into underlying tissue

Second and third degree burns may require hospitalization.

For many burns, treatment involves application of ice or cold compacts to relieve pain. Petroleum jellies can be applied if no blisters have formed, and the area can be covered with gauze bandages for a few days.

All chemical burns should be flooded with water prior to these actions. In the event of a severe burn, the person's life may be threatened due to systemic effects such as pain, fright, anxiety, hypovolemia and invasion of bacteria. In this situation, help should be sought immediately.

Causes

Thermal burns (the cause of most burns)
Fire
Scalding fluids
Steam
Excessive exposure to sunlight

Chemical burns
Strong acids, especially common household products
Strong alkali, especially common household products
Phenols
Cresols
Phosphorus
Mustard gas

Electrical burns
High tension electric wires
Household wiring
Lightning
Touching home appliances with wet hands

Signs & Symptoms

First degree burns
Redness
Tenderness
Swelling

Second degree burns
First degree symptoms
Blisters

Third degree burns
Second degree symptoms
Black or white areas due to dead, burned tissue

Nutritional Supplements

Structure & Function:
        Immune System Support &
        Hair, Skin and Nail Support

---------------------------------
General Supplements
---------------------------------

	Adult	Child/Adolescent
Aloe vera*
Arginine	500 - 1,000 mg	200 - 800 mg
B-Complex	hi-potency	hi-potency
Bee propolis***
DHEA*
Fish oils	3 - 5 g	2 - 3 g
EPO	1 - 3 g	1 - 2 g
Vitamin C	1,000 - 3,000 mg	500 - 2,000 mg
Vitamin E (Oral)	400 - 800 IU	200 - 400 IU
Vitamin E (Topical)	as tocopherol	(same)
Zinc	20 - 100 mg	10 - 50 mg

* Please refer to the respective topic for specific nutrient amounts.

**Aloe vera may also be consumed but is more usually applied topically for this condition.

***Bee propolis may be taken orally, or applied externally, as a salve ( both with honey).

Note:

All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Dietary Considerations

Burns heal with a great expenditure of energy and nutrients. Nutritional management is aimed at meeting this demand through adhering to a Protein Enriched Diet.

The rate of tissue breakdown and loss of body fat is greater for burns than for any other wound. Much of this decrease arises from the catabolism of muscle to meet the accelerated needs of the body for protein. For example, despite ingesting 40-60% of their estimated nutritional requirements, wound patients lost as much weight after three weeks as people undergoing starvation. The interpretation of this finding was that healing wounds require energy and protein expenditures above those spent on maintaining healthy tissue.

Protein is essential during all of convalescence. During the first two to six weeks of healing, protein is needed to mount the immune response and to effect healing.

There is an increased synthesis of white blood cells for combatting infection. These cells in turn use protein for forming antibodies, and other host-defense factors. Cells proliferate at the injury site and mend the burn.

In the weeks that follow, the body attempts to replace the diminished protein stores and repair the damaged muscle. There is still need for a Protein Enriched Diet at this stage.

Burns which are late in healing may become protein donors for the rest of the body if diet is insufficient. In this case, they may never heal well.

Protein needs are 50% or more above normal, and the individual may require 150 to 400 grams of protein per day.

Caloric needs are 50-100% above normal; it is not unusual to require 3,000 to 6,000 kilocalories per day during the healing process. Arginine and one to two grams of vitamin C are needed daily to promote tissue regeneration. Liberal doses of the vitamin B-Complex are advised to fuel the accelerated metabolism. Zinc supplements (100 to 200 milligrams per day) are advised to aid in healing.

Liberal amounts of fluids should be provided as there is great loss from wound exudates.

Homeopathic Remedy

Burns / Scalds

If the burn is larger than the palm of your hand, see a physician immediately.

1.* Cantharis                30C
2.* Urtica urens                15C use only for stinging sensation.
3.* Arnica montana tinct.        30C for healing
4. Thiosin aminum tinct.        30C for dissolution of scars
5. Calendula officinalis        3X to 15C

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Tissue Salts

Calc. Sulf.	purulent discharge;
Ferr. Phos.	inflammation, fever;
Kali Mur.	greyish-white exudate covers surface;

Herbal Approaches

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Herbs
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Aloe vera plant
Calendula (Marigold)
Comfrey
St. John's Wort

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Aloe gel has wonderful properties if available. Calendula (Marigold) gel is an alternative.

Otherwise, Comfrey is another traditional remedy, used in the form of a compress.

St. John's Wort (applied externally) is recommended by the German Commisssion E.

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Collins CE & Collins, C: Roentgen dermatitis treated with fresh whole leaf Aloe vera. Am. J. Roentgen. 1935, 33:396-397.

Hoffmann, D: The New Holistic Herbal. Element, 1983. Third edition 1990.

Robson, MC et al., Myth, magic, witchcraft or fact? Aloe vera revisited. J. Burn Care Rehab. 1982, 3:157-162.

Aromatherapy - Essential Oils

Calendula Essence,	Clary Sage Essence,
Eucalyptus Essence,	Lavender Essence,
Tea Tree Essence.

Related Health Conditions

Anxiety
Edema
Infection
Pain

Abstracts

References

Alexander, J. W. and Gottschlich, M. M.: Nutritional Immunomodulation in Burn Patients, Critical Care Medicine, February 1990;18(2):S149-S153.

Alpers, D.H., R.E. Clouse, and W.F. Stenson. 1983. Manual of Nutritional Therapeutics. Little, Brown, and Company, Boston. 457

Baker, J.L. The Effectiveness of Vitamin E In Reducing the Incidence of Spherical Contracture Around Breast Implants. Plastic and Reconstructive Surgery, 68 1981.

Bang RL & Dashti H: Keloid and hypertrophic scars: trace element alteration. Nutrition, 1995 Sep-Oct, 11:5 Suppl, 527-31.

Barton RG: Nutrition support in critical illness [see comments]. Nutr Clin Pract, 1994 Aug, 9:4, 127-39.

Bell SJ et al., The new dietary fats in health and disease. J Am Diet Assoc, 1997 Mar, 97:3, 280-6; quiz 287-8.

Berger MM et al., Influence of large intakes of trace elements on recovery after major burns. Nutrition, 1994 Jul-Aug, 10:4, 327-34; discussion 352.

Berkow, R. 1977. The Merck Manual. Merck Sharp and Dohme Research Laboratories Pub., Rahway, New Jersey. 2165 pp.

Bland, Jeffrey. Nutraerobics. San Francisco: Harper & Row, 1983.

Bland, Jeffrey. Medical Applications of Clinical Nutrition. New Canaan, Conn.: Keats, 1983.

Chasroff, I.J. & J.W. Ellis. 1983. Family Medical Guide, William Morrow and Company Inc., pub. 594 pp.

Cunningham JJ et al., Low ceruloplasmin levels during recovery from major burn injury: influence of open wound size and copper supplementation [see comments]. Nutrition, 1996 Feb, 12:2, 83-8.

Cuthbertson, D. P. 1964. Physical injury and it's effect on protein metabolism. Mammalian Protein Metabolism. Vol II. H.N. Munro and J. B. Allison, eds. Academic Press, N. Y.

Deitch EA: Nutritional support of the burn patient. Crit Care Clin, 1995 Jul, 11:3, 735-50.

Eagles, J.A. & M.N. Randall. 1980. Handbook of Normal and Therapeutic Nutrition. Raven Press, New York. 323 pp.

Eschleman, M.M. 1984. Introductory Nutrition and Diet Therapy. J.B. Lipincott Co., Philadelphia. 464 pp.

Garrel DR et al., Improved clinical status and length of care with low-fat nutrition support in burn patients. JPEN J Parenter Enteral Nutr, 1995 Nov-Dec, 19:6, 482-91.

Gerster H: The use of n-3 PUFAs (fish oil) in enteral nutrition. Int J Vitam Nutr Res, 1995, 65:1, 3-20.

Hegsted, M.D. 1976. Present Knowlege In Nutrition. 4th ed. The Nutrition Foundation Pub., Washington D.C. 605 pp.

Hutchinson, M. Nutrition and Cancer: Prevention and Treatment. Alas. Journal Of Medical Science, 21 (1984).

Kinney, J.M. 1983. Metabolic response to injury. Nutritional Support of the Seriously Ill Patient. R.W. Winters & H.L. Greene, Academic Press, NY

Kirschmann, J.D. 1990. Nutrition Almanac: Nutrition Search. McGrew-Hill: New York.

Koller J & Kvalteni K: Early enteral nutrition in severe burns. Acta Chir Plast, 1994, 36:2, 57-60.

Kuroiwa, K., et al: Effect of Vitamin A and Enteral Formulae For Burned Guinea-Pigs. Burns, 1990;16(4):265-272.

Mayes T et al., Clinical nutrition protocols for continuous quality improvements in the outcomes of patients with burns. J Burn Care Rehabil, 1997 Jul-Aug, 18:4, 365-8; discussion 364.

Moore, F.D. 1983. Surgical care and metabolic management of the post operative patient. Nutritional Support of the Seriously Ill Patient. R.W. Winters and H. L. Greene, eds. Academic Press, N.Y.

Nystrom, A. Zinc Metabolism in Diabetic Rats After Thermal Trauma. Acta Medica Scandinavica And Supplement, 687 (1984).

Parry-Billings, M. et al: Does Glutamine Contribute to Immunosuppression After Major Burns. The Lancet, September 1, 1990;336:523-525.

Pasulka, P. S. & Wachtel, T. L.: Nutrition Considerations For The Burned Patient. Surgical Clinics of North America/Burns, February 1987;67(1):109-131.

Petersdorf, R.G. & R.D. Adams. 1983. Harrison's Principles Of Internal Medicine. 10th ed. McGraw Hill Pub Co., New York. 2212

Prasad, A.S. Zinc Deficiency in Human Subjects. Progress In Clinical Biological Research, 129 (1983).

Preiser JC et al., Nitric oxide production is increased in patients after burn injury. J Trauma, 1996 Mar, 40:3, 368-71.

Rodriguez DJ: Nutrition in patients with severe burns: state of the art. J Burn Care Rehabil, 1996 Jan-Feb, 17:1, 62-70.

Sheridan RL et al., Physiologic hypoalbuminemia is well tolerated by severely burned children. J Trauma, 1997 Sep, 43:3, 448-52.

Subak-Sharpe, G.J. 1984. The Physician's Manual For Patients. Times Books Pub, New York. 607 pp.

Waymack, J. P. & Herndon, D. N: "Nutritional Support of the Burned Patient",., MD, World Journal of Surgery, 1992;16:80-86.

Yu YM et al., Relations among arginine, citrulline, ornithine, and leucine kinetics in adult burn patients. Am J Clin Nutr, 1995 Nov, 62:5, 960-8.

Yu YM et al., Plasma arginine and leucine kinetics and urea production rates in burn patients. Metabolism, 1995 May, 44:5, 659-66.