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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Fugazza G. 1, Aquilani R. 2, Iadarola P. 4, Dossena M. 3, Catapano M. 3, Boschi F. 3, Cobianchi A. 5, Pastoris O. 3
1 Department of Rehabilitation, “S. Maugeri” Foundation, IRCCS, Pavia, Italy;
2 Service of Nutritional Physiopathology, “S. Maugeri” Foundation, IRCCS Rehabilitation Center of Montescano (Pavia), Italy;
3 Institute of Pharmacology, University of Pavia, Pavia, Italy;
4 Institute of Biochemistry, University of Pavia, Pavia, Italy;
5 Centro Grandi Strumenti, University of Pavia, Pavia, Italy
BACKGROUND: The aim of the present study was to investigate whether patients with severe head injury (SHI) have a hypercatabolic state during their rehabilitation period.
METHODS: Eleven patients with SHI underwent the following evaluations: a) nutritional status (anthropometry, serum albumin levels, 24-hr creatinine urinary excretion); b) resting energy expenditure (REE: indirect calorimetry); c) 24-hr nitrogen urinary excretion; d) determination of plasma levels of lactate, pyruvate, glycerol, acetoacetate, β hydroxybutirate, total carnitine. All patients were fed enterally via a nasogastric tube. Eight healthy subjects, matched for sex and age, served as controls.
RESULTS: The patients with SHI showed an important reduction of body weight and skeletal muscles. Their REE was 91.2%±17.3% of predicted values. An adequate energy intake was found in only 5/11 patients. As a group, the patients had a negative nitrogen balance. Plasma concentrations in substrates were similar between the two groups. Esterified/free carnitine ratio and total carnitine were higher in patients than in controls (p<0.05 and p<0.01 respectively).
CONCLUSIONS: Catabolic non hypermetabolic processes may persist in rehabilitation patients with SHI, delaying and reducing functional recovery.