Recommended Nandrolone Dosage for Severe Burn Patients
For severe burn patients, nandrolone decanoate can be administered at a dose of 200 mg per week via intramuscular injection to combat catabolism and preserve lean body mass, although current guidelines do not strongly recommend its routine use due to insufficient consistent clinical data.
Evidence for Nandrolone in Burn Patients
Current Guideline Recommendations
Current nutritional guidelines for critically ill patients, including those with severe burns, acknowledge the use of anabolic steroids but do not provide strong recommendations for their routine use:
- The ESPEN guidelines (2017 and 2021) state there are "insufficient consistent clinical data to recommend currently approved androgenic steroids to increase muscle mass" 1.
- These guidelines specifically mention nandrolone decanoate at a dose of 200 mg per week as having been studied in cancer patients, showing a trend toward smaller weight loss 1.
Protein Requirements in Burn Patients
Burn patients have significantly increased protein requirements compared to other patient populations:
- Burn patients require 1.5-2 g/kg protein equivalents per day 1.
- Protein catabolism is a hallmark of burn injuries, with patients oxidizing amino acids at a rate 50% higher than baseline 1.
Recent Research on Nandrolone in Burns
Despite the lack of strong guideline recommendations, recent research supports nandrolone use in burn patients:
- A 2022 prospective randomized control study found that nandrolone decanoate showed "highly significant results supporting its use in combating catabolic insults in burns patients" with preservation of lean body mass and near-normal nitrogen balance 2.
- The study included burn patients with 20-40% total body surface area (TBSA) burns and demonstrated that nandrolone was both effective and safe 2.
Dosing and Administration
Recommended Dose
- Nandrolone decanoate: 200 mg per week via intramuscular injection 1, 2.
- This dosage has been studied in both cancer patients and burn patients with positive effects on preserving lean body mass.
Duration of Treatment
- Treatment should continue throughout the acute catabolic phase of burn injury.
- Monitor for clinical improvement in lean body mass and protein parameters.
Monitoring During Treatment
Parameters to Monitor
- Lean body mass preservation
- Nitrogen balance
- Protein partition
- Liver function tests (due to potential hepatic effects)
- In male patients: monitor for androgenic side effects
- In female patients: monitor for virilization effects
Alternative Anabolic Agents
Oxandrolone
If nandrolone is unavailable, oxandrolone has more robust evidence in burn patients:
- Oxandrolone at 0.1 mg/kg twice daily has been studied extensively in pediatric burn patients 3.
- In adult burn patients, oxandrolone has been associated with improved survival but potentially longer hospital stays 4, 5.
Clinical Considerations and Caveats
Patient Selection
- Consider nandrolone for patients with severe burns (>20% TBSA) who are at high risk for significant catabolism.
- May be particularly beneficial in patients with pre-existing sarcopenia or malnutrition.
Potential Side Effects
- Androgenic and virilizing effects
- Potential liver function abnormalities
- Fluid retention
- Alterations in lipid profiles
Combination Therapy
- Consider as part of a comprehensive nutritional strategy that includes:
Conclusion
While current guidelines do not strongly recommend nandrolone for routine use in burn patients due to limited high-quality evidence, the available research suggests that nandrolone decanoate at 200 mg weekly may help combat the severe catabolism associated with major burns. Recent research specifically in burn patients supports its efficacy and safety in this population.