Thermal injury in an adrenalectomized patient

The occurrence of thermal injury in an adrenalectomized patient on long-term 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.