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Diarrhea in Severely Burned Children

From the Shriners Burns Hospital and Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas

Correspondence: C. Lawrence Kien, MD, PhD, Dept. of Pediatrics, E203 Given Medical Building, University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405. Electronic mail may be sent to cl.kien{at}uvm.edu.

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.

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