## Stress Ulcer Prophylaxis in Burn Patients **Key Point:** Burn injury triggers a hyperacid state and increases risk of acute gastric ulceration (Curling's ulcer). Proton pump inhibitors (PPIs) are superior to H₂-receptor antagonists for prophylaxis in moderate-to-severe burns (≥15–20% TBSA). **High-Yield:** Omeprazole (or other PPIs) is the preferred agent for stress ulcer prophylaxis in burn patients because: - Superior acid suppression (pH >4 maintained longer) - Better healing of existing ulcers - Reduced transfusion requirements - More effective than H₂-blockers in preventing stress ulceration ### Comparison of Agents | Agent | Mechanism | Efficacy in Burns | Route | Notes | |-------|-----------|------------------|-------|-------| | **Omeprazole** | PPI | Excellent | PO/IV | First-line; superior to H₂-blockers | | Ranitidine | H₂-antagonist | Moderate | PO/IV | Inferior to PPIs; tachyphylaxis risk | | Famotidine | H₂-antagonist | Moderate | PO/IV | Inferior to PPIs; less tachyphylaxis | | Sucralfate | Mucosal protectant | Poor | PO | Limited efficacy; no systemic absorption | **Clinical Pearl:** Curling's ulcer (acute gastric ulceration after severe burn) occurs in up to 25% of burns >20% TBSA without prophylaxis. Modern PPI therapy has reduced incidence to <2%. **Mnemonic:** **PPI > H₂** in **BURNS**: **P**roton pump inhibitors **P**rovide **I**ncreased acid suppression, **B**etter **U**lcer **R**eduction, **N**eed **S**uperior prophylaxis. **Warning:** ~~Sucralfate~~ is no longer recommended as first-line for burn stress ulcer prophylaxis. It has poor efficacy and does not reduce transfusion requirements. [cite:ATLS 10th Edition Ch 7; Sheridan RL. Burn Care. Surg Clin North Am. 2005.]
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