**Question:** A young man weighing 65 kg was admitted to the hospital with severe burns in a severe catabolic state. An individual in this state requires 40 kcal per kg body weight per day and 2 gms of protein/kg body weight/day. This young man was given a solution containing 20% glucose and 4.25% protein. If 3000 ml of solution is infused per day -

A. 40 kcal x 65 kg x 1.17 (to convert kcal to MJ) = 853.9 MJ energy
B. 4.25 g x 65 kg x 2.2 (to convert protein to g) = 264.45 g protein
C. 3000 ml x 20% = 600 ml glucose
D. 3000 ml x 4.25% = 127.5 g protein

**Correct Answer:** .

**Core Concept:** In a severely catabolic patient like a burn victim, the energy requirements are increased due to the high rate of tissue catabolism and protein requirements are also increased to support tissue repair and protein synthesis.

**Why the Correct Answer is Right:** The patient's energy requirements are calculated considering the increased rate of tissue catabolism, which results in a higher energy demand. The conversion factors (kcal to MJ and protein to g) ensure that the energy and protein requirements are measured in a consistent and clinically relevant format.

**Why Each Wrong Option is Incorrect:**

A. The energy calculation uses the patient's weight, the energy requirement formula, and conversion factors. This option correctly calculates the patient's energy requirements.

B. Protein requirements are calculated based on the patient's weight, the protein formula, and conversion factors. This option correctly calculates the patient's protein requirements.

C. This option incorrectly calculates the glucose requirement by considering the glucose concentration in the solution, rather than the patient's energy requirements and protein needs.

D. This option incorrectly calculates the protein requirement by considering the protein concentration in the solution, rather than the patient's energy requirements and protein needs.

**Clinical Pearl:** It is essential to consider a patient's specific needs when administering intravenous fluids, particularly in critically ill patients like those with severe burns. This ensures that the patient receives the appropriate amount of energy, electrolytes, and nutrients, which is crucial for their recovery and preservation of tissue integrity.