Metabolic and nutritional sequelae in the non-steroid treated head injury patient.
Energy production, substrate oxidation, serum protein levels, and weight change were studied in 16 non-steroid treated patients with severe head injury. Patients were evaluated during an average of 31.3 days from hospital admission to discharge. The mean measured energy expenditure (MEE) was 1.40 +/- 0.5 times predicted energy expenditure. Caloric balance [calories received = calories expended] was achieved by the 2nd week. Despite caloric balance and the administration of at least 1.5 g of protein per kg of body weight per day, the mean nitrogen balance was negative. There was a positive nitrogen balance in only 2 patients. These patients received a mean of 1.43 times the MEE in total kilocalories and 2.3 g of protein per kg of body weight. Fat and protein oxidation exceeded protein and fat administration for 3 weeks postinjury. Albumin levels dropped from a mean of 3.09 +/- 0.2 on admission to 1.98 +/- 0.4 within 2 weeks. The initial retinol binding protein levels were within the normal range, and the levels increased over time. There was marked weight loss (mean, 15.6 +/- 5.9 lb). Head injury induces a profound traumatic response identified by increased energy expenditure, a negative nitrogen balance, weight loss, hypoalbuminemia, and altered substrate oxidation. This response seems to be caused by the head injury alone and is not due to the administration of corticosteroids.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001798:Blood Proteins / Q000378:metabolism; D001806:Blood Urea Nitrogen; D001835:Body Weight; D001930:Brain Injuries / Q000503:physiopathology*; D002153:Calorimetry, Indirect; D003128:Coma / Q000503:physiopathology; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012177:Retinol-Binding Proteins / Q000378:metabolism; D012709:Serum Albumin / Q000378:metabolism
D001798:Blood Proteins; D012177:Retinol-Binding Proteins; D012709:Serum Albumin