In general, calories are needed to supply the energy that is necessary for wound healing. Nutritional support generally includes some form of carbohydrates (parenteral dextrose, and enteral lactose, oligosaccharides, etc.). Glucose is a critical nutrient, especially in patients who have experienced significant trauma, such as a burn, as it is required for cellular growth, fibroblastic mobility, and leukocyte activity. As the metabolic rate increases, there is a concomitant increase in the conversion of amino acids to glucose and an increased rate of hepatic gluconeogenesis if adequate carbohydrate substrates are not provided.
Carbohydrates have been shown to impact wound healing in a variety of ways. Historically, carbohydrates have been viewed as an energy source for patients who are recovering from wounds. Differences have been noted in regards to carbohydrate requirements of patients who suffer from acute traumatic wounds (i.e., burns), acute iatrogenic wounds (i.e., incisions), and chronic wounds (i.e., diabetic wounds) (2). Under normal circumstances, the body increases glucose production via the liver and kidneys. This increase in gluconeogenesis is stimulated by a variety of hormones, including glucagons, epinephrine, and norepinephrine. Skin cells are glucose dependent for energy in cutaneous wound healing (3). Although adequate glucose levels are vital for wound healing, excessively high levels (hyperglycemia) have a negative impact on this process.
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