Burn patients have severe metabolic changes as the result of the burn injury and the inflammatory response.  Inhalation injury accentuates this response.  These changes lead to increased energy demands and loss of lean body thru net catabolism.  Nutritional support is a necessary component if care especially in this highly catabolic patient. 

Providing optimal nutritional support requires an understanding of how nutrients are utilized normally and then during the stress response.  This knowledge then allows for an assessment of current nutritional status, e.g. is the patient malnourished already?  Nutritional status cannot be simply assessed by physical exam.  The addition of biochemical markers is recommended.  Malnutrition is particularly prevalent in the elderly.  Nutritional needs can be determined with an understanding of the current state of the patient as well as the magnitude of the evolving “stress response”.  The method of delivery can then be selected.  Enteral nutrition is the first choice using a combination of voluntary intake in the form of meals and supplements.  Tube feeding is commonly used in large burns, as are the use of nutrient supplements.