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Nutrition in Toxic Epidermal Necrolysis
Author(s) -
Graves Caran,
Faraklas Iris,
Maniatis Katelynn,
Panter Elizabeth,
La Force Jessica,
Aleem Razia,
Zavala Sarah,
Albrecht Marlene,
Edwards Paul,
Cochran Amalia
Publication year - 2016
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0884533616642746
Subject(s) - medicine , toxic epidermal necrolysis , interquartile range , parenteral nutrition , enteral administration , psychological intervention , emergency medicine , pediatrics , surgery , dermatology , psychiatry
Background: Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe exfoliative diseases treated in burn centers due to large skin losses. Literature on SJS/TEN refers to parenteral nutrition (PN) as the preferred route of nutrition support. This study describes nutrition support interventions in SJS/TEN patients admitted to burn centers. Materials and Methods: Seven burn centers participated in this Institutional Review Board–exempted retrospective chart review of adults with SJS/TEN admitted from 2000–2012. Results: This analysis included 171 patients with SJS/TEN. Median total body surface area involvement was 35% (n = 145; interquartile range [IQR], 16%–62%). The majority required mechanical ventilation (n = 105). Based on indirect calorimetry, measured energy needs were 24.2 kcal/kg of admit weight (n = 58; IQR, 19.4–29.9). Thirty‐one patients did not require enteral nutrition (EN) and started oral intake on hospital day 1 (IQR, 1–2), and 81% required EN support due to inadequate oral intake and remained on EN until day 16 (median hospital day, 16; IQR, 9–25). High‐protein enteral formulas predominated. PN was rarely used (n = 12, 7%). Most patients were discharged home (57%), with 14% still requiring EN. Conclusions: Nutrition support should be considered in patients with SJS/TEN due to increased metabolic needs and an inability to meet these needs orally. Most SJS/TEN patients continued on EN and did not require escalation to PN.