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Ramesh, who weighs 71kg (154 pounds) is transfered to a burn center 4 weeks after sustaining a second and third-degree burn imjury to 45% of his total body surface area.Before to accident,the patients weight was 89kg (198 pounds).The patient has not been given anything by mouth since the injury except for antacids because of previous ulcer history.On physical examination,the patients burn wounds are clean,but only minimal healing is evident and thick adherent Escher is present.The patient's abdomen is soft and nondistended,and active bowel sounds are heard.His stools are trace-positive for blood,and he has a right inguinal hernia,which appears to be easily reducible.He has poor range of motion of all involved joints and has developed early axillary and popliteal fossae flexion contractures.For managing him,top priority must be given to correcting:
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