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Diarrhea in severely burned children
Kalpesh Thakkar1, C Lawrence Kien, Judah I Rosenblatt
1Shriners Burns Hospital, Texas, USA.
JPEN. Journal of Parenteral and Enteral Nutrition
|February 18, 2005
Summary
Diarrhea is common in critically ill patients on high-carbohydrate diets. This study found no link between carbohydrate intake or malabsorption and diarrhea, suggesting other causes and no need to change nutrition support.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Nutritional Support
Background:
- Diarrhea frequently affects critically ill patients receiving high-carbohydrate enteral nutrition.
- The osmotic effect of unabsorbed carbohydrates was hypothesized as a cause.
Purpose of the Study:
- To investigate the relationship between carbohydrate intake, malabsorption, and diarrhea in critically ill pediatric burn patients.
- To determine if carbohydrate malabsorption contributes to diarrhea in this population.
Main Methods:
- Studied 19 pediatric burn patients (>40% total body surface area) for up to 4 weeks postburn.
- Measured breath hydrogen (H2) concentration to assess carbohydrate malabsorption.
- Recorded enteral carbohydrate intake, stool volume, and fluid intake weekly.
Main Results:
- Diarrhea (stool volume >10 mL/kg/d) occurred in 18 of 19 patients.
- No significant correlation was found between breath H2 levels, carbohydrate intake, and stool volume.
- Maximal stool volume did not consistently align with maximal carbohydrate intake.
Conclusions:
- Carbohydrate malabsorption does not appear to be the primary cause of diarrhea in these critically ill burn patients.
- The etiology of diarrhea in this cohort may be multifactorial, unrelated to carbohydrate load.
- Current data do not support modifying nutritional support regimens solely based on watery diarrhea in this patient group.