title: Nutrition in Toxic Epidermal Necrolysis: A Multicenter Review.
abstract: 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.
  
  
  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.
authors.affiliation: 1 Burn Center at the University of Utah and the Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
authors.forename: Caran
authors.initials: C
authors.lastname: Graves
authors.affiliation: 1 Burn Center at the University of Utah and the Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
authors.forename: Iris
authors.initials: I
authors.lastname: Faraklas
authors.affiliation: 2 Sunnybrook Health Sciences Center, Toronto, Canada.
authors.forename: Katelynn
authors.initials: K
authors.lastname: Maniatis
authors.affiliation: 3 Johns Hopkins Burn Center, Baltimore, Maryland, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Panter
authors.affiliation: 4 University of California, Davis Medical Center, Sacramento, California, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: La Force
authors.affiliation: 5 Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Razia
authors.initials: R
authors.lastname: Aleem
authors.affiliation: 5 Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Zavala
authors.affiliation: 6 Arizona Burn Center, Phoenix, Arizona, USA.
authors.forename: Marlene
authors.initials: M
authors.lastname: Albrecht
authors.affiliation: 7 CHI Health St Elizabeth, Lincoln, Nebraska, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Edwards
authors.affiliation: 1 Burn Center at the University of Utah and the Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
authors.forename: Amalia
authors.initials: A
authors.lastname: Cochran
mesh_terms: D002053:Burn Units; D006760:Hospitalization; D006801:Humans; D009752:Nutritional Status; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome
keywords: Stevens-Johnson syndrome; enteral nutrition; indirect calorimetry; nutritional support; parenteral nutrition; toxic epidermal necrolysis