What is the recommended timing for initiating enteral nutrition in severe burns and typical daily caloric and protein targets?

• A. Early enteral nutrition within 24–48 hours; about 30–40 kcal/kg/day and 1.5–2.0 g/kg/day protein
• B. Delay nutrition until day 5; 10 kcal/kg/day and 0.5 g/kg/day protein
• C. Within 6 hours; 60 kcal/kg/day and 3 g/kg/day protein
• D. Parenteral nutrition only

Answer: (A)

In severe burns, the body undergoes a large hypermetabolic and catabolic stress response, so meeting energy and protein needs early is essential to support healing, preserve gut integrity, and reduce infection risk. The best approach is to start enteral nutrition early, within the first 24 to 48 hours after injury, rather than delaying nutrition. This early feeding helps maintain the mucosal barrier, supports immune function, and lowers the likelihood of infectious complications.

The caloric target should be in the moderate range for burns—about 30–40 kcal per kilogram per day—to provide enough energy for healing without overwhelming the patient. Protein needs are high to support tissue repair and nitrogen balance, typically about 1.5–2.0 g per kilogram per day. These targets balance the demanding metabolic needs of burn injury with the risk of overfeeding.

Choosing to delay nutrition to day five misses the opportunity to blunt catabolism early and can worsen outcomes. Providing very high early feeding, such as 60 kcal/kg/day with 3 g/kg/day protein, increases the risk of metabolic complications. Relying on parenteral nutrition alone ignores the benefits of the gut and is not the recommended first-line approach when enteral feeding is feasible.

So, initiating enteral nutrition within 24–48 hours with around 30–40 kcal/kg/day and 1.5–2.0 g/kg/day protein reflects the best-supported practice for severe burns.