Nutritional and Metabolic Response to Acute Spinal‐Cord Injury

Abstract

The metabolic response to complete spinal cord injury was prospectively studied in 10 patients with Frankel class A spinal cord injury. Weekly excretory and balance studies profile the changes in nitrogen, calcium, and 3-methylhistidine excretion in relation to body weight and metabolic rate. The initial resting energy expenditures were 10% below what was predicted, and body weight decreased by 10%. Nitrogen excretion paralleled the changes in body weight. Calcium excretion increased for 3 weeks and reached a plateau 150% above baseline. Our results chronicle the magnitude of metabolic response to spinal shock. Comparison with reported values shows this response exceeds that seen in immobilized patients. Nitrogen excretion rose to levels seen in highly stressed patients and must be considered in the management of patients with acute spinal-cord injury.

Continuous positive airway pressure requirements in patients with tetraplegia and obstructive sleep apnoea

“…However, there was a significant difference in BMI between acute tetraplegia and controls with acute tetraplegia in the 'overweight' range and controls in the 'severely obese' range. Acute tetraplegia is associated with a hypermetabolic state 14,15 and a lower body weight. 14 Weight then gradually increases over time, particularly in the first year after rehabilitation, 16 such that those with chronic tetraplegia eventually become overweight or obese.…”

Nutritional Support After Spinal Cord Injury

“…1,3,5,7,9,[12][13][14][15] Fewer studies have focused on hypermetabolism, catabolism, and nitrogen losses following acute SCI. 4,7,10,16,17 While there are metabolic similarities between isolated traumatic brain injury and severely isolated SCI, it appears there may be important biological differences between the 2 central nervous system (CNS) injury types that have bearing on supplemental nutritional therapy. [4][5][6][7][8]16,17 Severe head injury is associated with a resting energy expenditure (REE) of approximately 140% of predicted normal basal energy expenditure 3,5,7,[12][13][14][15] Indirect calorimetry is the most widely used reliable means to determine individual energy requirements in hospitalized patients after traumatic injury.…”

“…4,7,10,16,17 While there are metabolic similarities between isolated traumatic brain injury and severely isolated SCI, it appears there may be important biological differences between the 2 central nervous system (CNS) injury types that have bearing on supplemental nutritional therapy. [4][5][6][7][8]16,17 Severe head injury is associated with a resting energy expenditure (REE) of approximately 140% of predicted normal basal energy expenditure 3,5,7,[12][13][14][15] Indirect calorimetry is the most widely used reliable means to determine individual energy requirements in hospitalized patients after traumatic injury. 3,[5][6][7] It requires the use of a portable metabolic cart and employs a technique that measures respiratory gas exchange and the rate of oxygen utilization in a given patient.…”

“…3,[5][6][7] The Harris-Benedict equation, with activity and stress of injury variables, has been shown to predict energy expenditure after traumatic brain injury (TBI) with reasonable accuracy without indirect calorimetry. 3,6,7,16,17 Nutritional support of head-injured patients is typically begun within days of admission and is guided by the metabolic information provided by indirect calorimetry and by predicted energy expenditure values derived by equation. Hypermetabolism, accelerated catabolism, and excessive nitrogen losses continue for at least 2 weeks after injury.…”

“…3,[5][6][7]10 Nitrogen balance is difficult and often impossible to achieve, particularly within the first week of injury. 1,3,4,16,17 Matching nutritional replacement with caloric needs has therefore become the primary goal of nutritional therapy.…”