Burn injury results in profound metabolic abnormalities perpetuated by an e
xaggerated stress response to injury. Hypermetabolism and marked catabolism
, with rapid erosion of lean body mass, becomes evident shortly after injur
y. Much of the morbidity and mortality of a major burn can be attributed to
this process, which increases infection risks, decreases the healing rate,
and alters cell function. Rapid removal of devitalized burn tissue combine
d with early aggressive nutritional support significantly attenuates this a
utodestructive process. The addition of anabolic agents decreases the degre
e of lean mass loss and increases the rate of restoration. Immediate attent
ion to the metabolic response to a severe burn significantly decreases comp
lications and improves outcome.