**4. Pathophysiological effects of burn injury**

Pathophysiological effects of burn injury can be divided into local and systemic [11].

The local effects include release of inflammatory mediators from the capillary walls, white blood cells, and platelets. These inflammatory mediators result in vasodilatation and increased vessel permeability that leads to fluid loss from the circulation into the interstitial space [11].

Systemic effects occur in extended burns (usually in those that burned surface area exceeds 20% of total body surface area) and include hypovolemia, immunosuppression, catabolism, loss of the protective function of the gut, and pulmonary edema [11].

A major burn injury leads to fluid and electrolyte imbalance with systemic intravascular losses of water, sodium, albumin, and red blood cells. If the intravascular volume is not rapidly restored, the shock develops [1]. Moreover, burns can lead to malnutrition and organ dysfunction due to metabolic disturbances (hypermetabolism and muscle catabolism) [1].
