What is the typical metabolic state after a major burn and how does it influence nutrition planning?

• A. Hypermetabolic and hypercatabolic state; requires higher caloric and protein intake to support wound healing and immune function.
• B. Hypometabolic state; requires reduced caloric intake.
• C. Normal metabolic state; standard nutrition suffices.
• D. Metabolic state not relevant.

Answer: (A)

Major burns drive a sustained hypermetabolic and hypercatabolic response, meaning energy needs soar and protein is rapidly broken down to fuel wound healing, immune function, and stress responses. Because of this increased demand, nutrition planning must provide substantially more calories and protein than usual. In practice, aim for calories around 1.5 to 2 times the measured resting energy expenditure (or use indirect calorimetry if available) and protein roughly 1.5 to 2.5 g per kilogram per day, with higher targets for larger burns. Begin early—preferably with enteral nutrition within the first 24 to 48 hours—to preserve gut integrity and support healing, then advance as tolerated. Monitor for complications like hyperglycemia and adjust with appropriate insulin therapy while ensuring adequate micronutrients, since these support immune function and tissue repair. This approach reflects the ongoing metabolic stress after a major burn, unlike a hypometabolic or normally fed state, which would not necessitate these elevated targets.