METABOLIC RESPONSES AND NUTRITIONAL THERAPY IN PATIENTS WITH SEVERE HEAD-INJURIES

The severe hypermetabolism and hypercatabolism seen in patients with s evere head injuries results in malnutrition that occurs very rapidly a nd can cause impaired healing and an increased tendency to infection a nd multiple organ failure. Thus, early adequate nutritional support pl ays a role in functional outcome. Total enteral nutrition (TEN) is pre ferred over total parenteral nutrition (TPN), but TPN should be suppli ed promptly while increasing TEN to a goal of at least 25 to 35 nonpro tein kcal/kg/d and 2.0 to 2.5 g protein/kg/d. Nutritional formulas hig h in branched chain amino acids, glutamine, arginine, vitamins E and C , and zinc may also have some advantages. Growth hormone may improve a nabolism. Hyperglycemia, especially glucose levels exceeding 200 mg/dL , must be prevented and/or treated promptly with insulin or decreased glucose intake. Careful monitoring with indirect calorimetry and nitro gen balance studies should help prevent inadequate protein or excessiv e carbohydrate intake.