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An aggressive enteral nutritional approach has been employed to support our severely burned patients. The diet is based on a daily intake of 5 eggs/10 kg of body weight, incorporated into milkshakes. Twelve patients with severe burns (age, 24 +/- 4 years; burns, 54 +/- 12 per cent of total body surface area (TBSA] were studied. Enteral feeding was initiated on the day of injury and gradually reached the full formula within 3-7 days. Feeding was carried out either orally or through a nasogastric drip or a combination of both, depending on the patient's condition. Each bottle of milkshake contained 2318 kJ, 29 g protein, 51 g carbohydrate and 28.6 g fat in 250 ml. Each millilitre of the diet contained 9.32 kJ. The protein provided 21 per cent of the total calorie intake, while the fat and carbohydrate provided 42 per cent and 37 per cent respectively. The mean daily intake consisted of protein (5 +/- 1.5 g/kg), carbohydrate (8 +/- 0.75 g/kg) and fat (5 +/- 1 g/kg), providing a daily administration of 378-420 kJ/kg. Plasma lipids remained within normal limits during the 40 days of the diet, while serum protein levels rose to normal levels within the first 3 weeks.

The efficacy of prophylactic therapy with cimetidine or antacids combined with early enteral feeding to prevent gastrointestinal bleeding in patients with severe burns was evaluated. Fifty patients with burns exceeding 30 per cent of the total body surface area (TBSA) were divided into two groups, each of them treated by one of these agents in combination with early feeding. Bleeding was not encountered in either group. It is assumed that the combination of either agent with enteral feeding early in the post-burn course equally protected against gastrointestinal bleeding. Because of the ease and lack of side-effects of cimetidine in this series, its use was preferable.