Cold Injury

glycemic after thermal injury and frequently require an insulin drip. The insulin infusion should be titrated to maintain tight control of serum glucose to avoid glycosuria. Tn diabetic burn patients, glycosuria can be present at seemingly insignificant elevations of serum glucose levels, frequently leading to hypovolemia and hyperosmolality. Diabetic intestinal dysmotility and delayed gastric emptying should be managed by postpyloric placement of a feeding tube and the selective use of metoclopramide. The use of insulin infusion to obtain tight control of serum glucose will usually allow delivery of standard enteral formulations. Diabetics with large burns may benefit from a decrease in carbohydrate calories and an increase in the proportion of calories from proteins and fatty acids.