“… 1–3 ED can also cause secondary hemodynamic and metabolic disturbances. 4–7 Disturbance in protein metabolism usually occurs due to protein lost from the skin and gastrointestinal tract; however, when the scaling is severe, 8–10 or the protein lost is more than 17 g/m 2 /day, 11 a negative nitrogen balance can occur causing hypoalbuminemia, edema, and loss of muscle mass.…”