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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 1998 Settembre;34(3):125-9
The persistence of hypercatabolic state in rehabilitation patients with complicated head injury
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.