MEASURED ENERGY-EXPENDITURE AND PLASMA SUBSTRATE AND HORMONAL CHANGESAFTER SEVERE HEAD-INJURY

The influence of head trauma on the pattern of response to injury has been studied. Metabolic and hormonal data from brain injured patients over 20 days following injury were compared with an existing data base from non-head-injury patients and control subjects. The results demon strated elevated concentrations of plasma glucose, lactate, non-esteri fied fatty acids (NEFA), cortisol, glucagon and insulin above that of control values in both groups after injury. Head injury as a separate factor did not affect the concentrations of any of these plasma substr ates and hormones independently of its contribution to the Injury Seve rity Score (ISS). However, plasma catecholamine concentrations were hi gher in the head injured initially and at 7 days after injury. All hea d-injured patients showed an increase in metabolic rate (above predict ed values) at some stage after injury. It should be noted, however, th at there were some features of head injury (and its treatment) such as paralysis, ventilation and fasting which were not matched in the non- head-injured group. It was concluded that the metabolic changes occurr ing after head injury are similar to those occurring after extracrania l injury and that therapeutic intervention has a major effect on the l evel of energy expenditure seen in these patients.