Thermal injury in an adrenalectomized patient

The occurrence of thermal injury in an adrenalectomized patient on longterm steroid replacement therapy illustrated the role of adrenal hormones in the systemic responses to thermal injury. This unusual patient demonstrated an inadequate response to fluid resuscitation and excessive third-space fluid losses, defective thermogenesis, profound nutritional abnormalities, impaired wound healing, and compromised immunologic function. Nutritional support required correction of calorie-nitrogen proportions from 180:1 to 90:1, following which the patient was in positive nitrogen balance.