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Thomas R. Ziegler, MD; Robert J. Smith, MD; Sarah T. O'Dwyer, FRCS; Robert H. Demling, MD; Douglas W Wilmore, MD

Arch Surg. 1988;123(11):1313-1319.

Abstract
• Thermal injury may be associated with disruption of normal gut barrier integrity. To test this hypothesis, we assessed intestinal permeability with the nonmetabolizable, poorly absorbed disaccharide lactulose, which is efficiently excluded by the normal intestinal mucosa. Permeability studies were performed in 15 burned patients (aged 18 to 67 years; mean burn size, 40%) and 11 healthy controls. Lactulose, 10 g, was administered enterally, together with 5 g of mannitol as a control, and urinary excretion rates were determined. Lactulose excretion and the lactulose/mannitol excretion ratio increased threefold (160±30 vs 57±7 µmol and 0.113±0.033 vs 0.035±0.005) in the infected patients (sepsis score, 10±2; burn size, 38%±6%). In contrast, noninfected burn patients (sepsis score, 0) had permeability values similar to those of controls (66±10 µmol and 0.036±0.007). Permeability increased as the severity of infection increased. Infection in burn patients is associated with increased bowel permeability. The intestine may be a primary source of sepsis. Alternatively, the systemic response to infection may alter gut barrier function, which could facilitate translocation of bacteria and absorption of endotoxin.

(Arch Surg 1988;123:1313-1319)

Author Affiliations
From the Departments of Surgery (Drs Ziegler, O'Dwyer, Demling, and Wilmore) and Medicine (Dr Smith), Brigham and Women's Hospital, and the Joslin Diabetes Center (Dr Smith), Harvard Medical School, Boston.

Footnotes
Accepted for publication June 23, 1988.

Read before the Eighth Annual Meeting of the Surgical Infection Society, San Francisco, May 5, 1988.

Reprint requests to Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02215 (Dr Wilmore).

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