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Diarrhea in Severely Burned Children
Author(s) -
Thakkar Kalpesh,
Kien C. Lawrence,
Rosenblatt Judah I.,
Herndon David N.
Publication year - 2005
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/j.1941-2444.2005.tb04839.x
Subject(s) - diarrhea , enteral administration , medicine , malabsorption , carbohydrate , gastroenterology , parenteral nutrition
Background : Diarrhea is a common problem in critically ill patients. Our patients are fed a high‐carbohydrate enteral formula. We hypothesized that diarrhea in our patients may be related to the osmotic effects of unabsorbed carbohydrate in the small intestine and colon. Methods : We studied 19 patients, 3 months to 17 years, with burns >40% total body surface area. Each subject was studied weekly for up to 4 weeks postburn. Breath H 2 concentration was measured. For the 24‐hour period before the breath H 2 measurement, the enteral carbohydrate intake, stool volume, and total enteral fluid volume were recorded. At each of several weekly intervals for each subject, the times when stool volume and enteral carbohydrate intake were each maximal were noted. Results : Maximal stool volume ranged from 12 to 69 mL/kg/d. At the time point of maximal carbohydrate intake, diarrhea (stool volume >10 mL/kg/d) occurred in 18 of 19 patients, and maximal stool volume occurred in 10 of 19. Breath H 2 concentration (ppm/5% CO 2 ; mean ± SEM) was 5.5 ± 3.5 at the time of maximal carbohydrate intake, and was 25 ± 20 at maximal stool volume. There were no correlations among breath H 2 concentration, stool volume, enteral fluid intake, and enteral carbohydrate intake. Conclusions : Almost all the subjects had diarrhea over several weeks postburn. The lack of correlation of either carbohydrate intake or breath H 2 with stool volume suggests that diarrhea in these patients may be caused by factors other than carbohydrate malabsorption. These data do not support altering nutrition support because of watery diarrhea.