Early enteral feeding of patients with major burns: prevention of catabolism.

The immediate onset of hypermetabolism after a major burn dictates that nitrogen and calories be supplied as early as possible to such patients to prevent the well-documented catabolic state. However, intravenous hyperalimentation is not always possible, and enteral feeding is not usually attempted in the early resuscitative period. Twelve patients with major burns (40% to 70%) were fed nasoduodenally in the early postburn period with a new solution (3.5% Aminosyn, 25% Polycose, and appropriate additions of electrolytes and vitamins). All patients reached positive nitrogen balance in 9.8 +/- 2.3 days, tolerated the feeding extremely well, and had no distention or diarrhea. Metabolic assessment showed remarkable stability. The characteristic signs of hypermetabolism, such as hyperglycemia and hypoinsulinemia or hyperinsulinemia, were absent. Furthermore, there was no persistent neutrophilia or leukocytosis and there was a significant (p less than .01) decrease in the percentage of juvenile neutrophils and a significant (p less than 0.001) increase in absolute lymphocytes between days 0 and 14 of the study. These data indicate that early enteral feeding of Polycose-Aminosyn is safe and well tolerated, and that the small intestine absorbs nutrients readily in the early postburn period, leading to positive nitrogen balance, preventing loss of serum protein, assisting in the maintenance of normal carbohydrate metabolism, and restoring granulocytes and lymphocytes to normal ratios.