Nutrition in Toxic Epidermal Necrolysis

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 supp...

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Bibliographic Details
Published in:Nutrition in clinical practice 2016-12, Vol.31 (6), p.836-840
Main Authors: Graves, Caran, Faraklas, Iris, Maniatis, Katelynn, Panter, Elizabeth, La Force, Jessica, Aleem, Razia, Zavala, Sarah, Albrecht, Marlene, Edwards, Paul, Cochran, Amalia
Format: Article
Language:English
Subjects:
enteral nutrition
indirect calorimetry
nutritional support
parenteral nutrition
Stevens‐Johnson syndrome
toxic epidermal necrolysis
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Summary: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. Materials and 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.
ISSN:0884-5336
1941-2452
DOI:10.1177/0884533616642746