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Energy Requirements of Pediatric Patients With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

From ¹ Shriners Hospitals for Children, Cincinnati, OH, and ² Cincinnati Children's Hospital Medical Center.

Correspondence: Address correspondence to: Theresa Mayes, Shriners Hospitals for Children, Nutrition Services, 3229 Burnet Ave, Cincinnati, OH 45229-3018; e-mail: smsmith{at}shrinenet.org.

Introduction: The primary purpose of this study was to compare the measured resting energy requirements (MREE) of children with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with that of children with burns of similar size. A secondary goal was to develop a predictive equation useful in estimating the energy of children with SJS/TEN. Methods: This retrospective study included 30 patients admitted to our pediatric burn unit between 12/91 and 03/06. All patients were admitted within 10 days of injury and had at least 1 metabolic cart measurement. Fifteen patients with SJS/TEN comprised group 1. Group 2 consisted of 15 burn patients matched for total wound size, age, preinjury weight, and gender. Caloric intake and discharge weight (percent of preburn weight) were recorded. Results: The energy needs of the SJS/TEN group were 22% less than the burn group. Correlation between MRE x 1.3 and caloric intake was 0.89 for the SJS/TEN group and 0.92 for the burn group (P < .0001). Both the SJS/TEN and burn groups were managed by nutrition goals based on the MREE x 1.3, and patients were 95.1% ± 6.3% and 98.9% ± 6% of preinjury weight at discharge, respectively, in each group. An equation for the estimation of energy requirements in pediatric SJS/TEN patients was statistically generated: (24.6 x weight in kg) + (% wound x 4.1) + 940. Conclusion: The energy requirement in pediatric SJS/TEN patients is less than that following burn injury. The application of a 30% factor to MREE is supported in SJS/TEN and thermal injury.

Key Words: energy metabolism • energy expenditure • Stevens-Johnson Syndrome • toxic epidermal necrolysis

Nutrition in Clinical Practice, Vol. 23, No. 5, 547-550 (2008)
DOI: 10.1177/0884533608323434


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