a See also Cohen, A. et al., J. Biol. Chem., 258, 12334, 1983. b See also Chen, P. and Abramson, F.P., Anal. Chem., 70, 1664, 1998. c See also Zhang, X.J. et al., J. Nutr., 134, 2401, 2004.

function, and the immune system.37 Severe protein malnutrition, when body cell mass losses exceed 40%, may result in death.38

Therefore, the objective of protein therapy during burn injuries is to minimize net protein catabolism, promote wound healing, and preserve lean body mass. Although protein requirements are significantly elevated in adult burn patients, it should be noted that protein intake greater than 1.5 g of protein per kilogram per day has not been shown to provide any advantage and can result in increased concentrations of urea and ammonia (see Chapter 5). In addition, excess protein intake may compromise bone health by promoting hypercalciuria. Specifically, excess dietary protein intake induces low-grade metabolic acidosis and subsequently decreases renal tubular reabsorption of calcium,39 increases cell-mediated bone resorption,40 and increases direct physiochemical dissolution of bone.41

For children with severe burn injuries, protein intake at 2.5 to 3 g of protein per kilogram is sufficient to promote wound healing.42 However, protein intake equal to 4 to 5 g of protein per kilogram may also help maintain lean body mass. This may be particularly important in larger burns characterized by elevated protein losses via the wound. Protein intake over 5 g/kg may be harmful. This is of utmost concern in very young children if intake exceeds the renal solute load (see Chapter 13).

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