Trauma, sepsis, and burns cause abnormal manifestations in the body. These manifestations can cause alterations in body metabolism, which complicates nutritional management. Goals of nutrition support with assessment modifications for a constantly changing population are reviewed. Patients in such stress states as burns, trauma, and sepsis many times need altered nutrition. This article outlines guidelines for total parenteral formula modification and monitoring, and discusses other complications such as drug interactions with parenteral formulas.