title: The metabolic response to severe head injury.
abstract: Caloric expenditure and nitrogen balance were measured in 14 steroid-treated comatose head-injured patients acutely and up to 28 days after injury. During this period patients were fed with a continuous enteral infusion of a formula containing 2 Kcal/cc and 10 gm nitrogen/liter. Indirect calorimetry was carried out for 102 patient-days. The mean resting metabolic expenditure (RME) for nonsedated nonparalyzed patients was 138% +/- 37% of that expected for an uninjured resting person of equivalent age, sex, and body surface area. Nitrogen excretion was measured for 135 patient-days. The mean excretion was 20.2 +/- 6.4 gm/day. The mean protein caloric contribution was 23.9% +/- 6.7% and was greater than 25% for six patients, compared to normal values of 10% to 15%. Despite hyperalimentation, positive nitrogen balance for any 3-day period was achieved in only seven patients, and required replacement of 161% to 240% of RME with enterally administered formula. Head-injured patients had a metabolic response similar to that reported for patients with burns of 20% to 40% of the body surface.
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000378:metabolism* / Q000628:therapy; D003128:Coma / Q000378:metabolism / Q000628:therapy; D004734:Energy Metabolism; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism / Q000652:urine; D009747:Nutritional Physiological Phenomena; D010101:Oxygen Consumption
chemical_list: D009584:Nitrogen