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Europa Medicophysica 1998 September;34(3):125-9

Copyright © 1998 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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