Alterations in intestinal permeability after thermal injury
T. LeVoyer, W. G. Cioffi Jr, L. Pratt, R. Shippee, W. F. McManus, A. D. Mason Jr and B. A. Pruitt Jr
US Army Institute of Surgical Research, Fort Sam Houston, TX 78234-5012.
Alterations in intestinal permeability have been postulated to occur after
thermal injury. We evaluated the status of intestinal permeability during
the first 2 postburn weeks in 15 subjects by measuring the differential
excretion of enterally administered lactulose and mannitol. The mean age
and burn size of the patients were 32.7 +/- 3.6 years and 53.3% +/- 5.1% of
the total body surface area, respectively. Ten healthy volunteers were also
studied. The lactulose-mannitol excretion ratio was 0.159 +/- 0.017 for the
patients and 0.017 +/- 0.003 for controls. The increased ratio did not
correlate with burn size or postburn day. Patients who developed
significant clinical infections during their first 2 postburn weeks had
lactulose-mannitol ratios on postburn day 2 that were significantly higher
than those of controls and patients who did not develop infections. This
suggests a relationship between susceptibility to infection and early
alterations in intestinal permeability.
