As presented in the section on “Metabolic Changes in the Burn Patient” it is clear that the “stress response” needs to be treated.  One of the key anabolic strategies, to a catabolic state, is nutritional support.

A major burn patient needs to have good nutrition initiated to avoid excessive lean mass loss and resulting weakness.  Immediate nutritional support is indicated to manage the severe “stress response” because of the marked catabolism which will rapidly ensue. Immediate nutrition is also indicated for the patient already malnourished.  The degree of nutritional support corresponds with burn size.  The presence of a smoke inhalation injury further increases the metabolic demands. The increased protein, energy and micronutrient demands need to be met before complications caused by loss of body weight, mainly lean mass, and protein energy malnutrition develop.

Because the maladaptive hormonal environment and inflammatory focus will persist, nutrition will attenuate but not eradicate the “stress response” as discussed in the “metabolism” section.  Controlling the underlying stressors is still necessary for nutritional therapy to obtain optimal beneficial effects.

The addition of anabolic activity is needed to decrease the utilization of protein for fuel, the metabolic abnormality in nutrient partitioning caused by stress.