A preliminary report of the pharmacokinetics and efficancy of cimetidine in maintaining gastric pH greater than six in patients following major thermal injury

Curling reported duodenal ulceration to thermal injury in 1842, and since that time acute ulceration and inflammatory changes in the distal esophagus, stomach, and duodenum have benn a recognized complication of thermal injury. These pathologic changes are potential precursors of hemorrhage and perforation, and of concern in the treatment of patients with thermal injury. Cimetidine, an H2-histamine receptor antagonist, is effective in elevating intragastric pH values in unburned critically ill patients, however, is not consistent. In burn patients, McElwee and associates have demonstrated endoscopically that cimetidine is as efficacious as antacid pH elevation in decreasing the incidence of ulceration and complications. Intragastric pH values were not reported. The purpose of this investigation was to evaluate the effects of cimetidine on intragastric pH in patients immediately following major burns, and examine the pharmacokinetics of cimetidine in this patient population both pre and post-resuscitation. This data should be of value in developing a pharmacologically and pharmacokentically sound protocol using cimetidine prophylactically to prevent ulceration and complications. This evaluation also served as a pilot study to the investigation of similar parameters in a larger patient population.