PROTEIN AND ENERGY-REQUIREMENTS IN PATIEN TS WITH SEVERE HEAD-INJURY

The aim of the present study was to assess the effect of severe head i njury over resting energy expenditure and nitrogen losses. Eight patie nts with severe head trauma (mean Glasgow scale of 4,9 +/- 1.6), subje cted to emergency craniotomy were studied; four patients had septic co mplications and none received steroids. Energy expenditure was measure d using indirect calorimetry and nitrogen losses were assessed measuri ng 24 h urea nitrogen excretion on days 1, 4, 7 and 10 of the postoper ative period. Twelve healthy males composed the control group. Measure d energy expenditure in patients, evaluated in 22 occasions, was 35 +/ - 9.8 Kcal/kg/day or 145 +/- 41% of the estimation according to Harris -Benedict equations, compared to 22.0 +/- 4.6 Kcal/kg/day or 89 9 +/-1 7.5% in the control group (p < 0. 001) 24 h urinary urea nitrogen exc retion in patients was 18 +/- 12 g/day (range 5.2-46.9) and the catabo lic index was 7 4 +/- 13.5. It is concluded that, due to the great ind ividual variability in measured energy expenditure in these patients a nd their hypercatabolism, indirect calorimetry and nitrogen balance st udies become useful tools to perform an adequate nutritional support,