Diarrhea in severely burned children.
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 H2 concentration was measured. For the 24-hour period before the breath H2 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 H2 concentration (ppm/5% CO2; 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 H2 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 H2 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.
Thakkar
Kalpesh
K
Shriners Burns Hospital, Texas, USA.
Kien
C Lawrence
CL
Rosenblatt
Judah I
JI
Herndon
David N
DN
D000293:Adolescent; D001944:Breath Tests; D002056:Burns / Q000503:physiopathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D003967:Diarrhea / Q000209:etiology* / Q000378:metabolism; D004040:Dietary Carbohydrates / Q000378:metabolism* / Q000493:pharmacokinetics; D004750:Enteral Nutrition / Q000009:adverse effects*; D005526:Food, Formulated / Q000009:adverse effects; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D007223:Infant; D007408:Intestinal Absorption
D004040:Dietary Carbohydrates; D006859:Hydrogen