Measured energy expenditure and plasma substrate and hormonal changes after severe head injury.

The influence of head trauma on the pattern of response to injury has been studied. Metabolic and hormonal data from brain injured patients over 20 days following injury were compared with an existing data base from non-head-injured patients and control subjects. The results demonstrated elevated concentrations of plasma glucose, lactate, non-esterified fatty acids (NEFA), cortisol, glucagon and insulin above that of control values in both groups after injury. Head injury as a separate factor did not affect the concentrations of any of these plasma substrates and hormones independently of its contribution to the Injury Severity Score (ISS). However, plasma catecholamine concentrations were higher in the head injured initially and at 7 days after injury. All head-injured patients showed an increase in metabolic rate (above predicted values) at some stage after injury. It should be noted, however, that there were some features of head injury (and its treatment) such as paralysis, ventilation and fasting which were not matched in the non-head-injured group. It was concluded that the metabolic changes occurring after head injury are similar to those occurring after extracranial injury and that therapeutic intervention has a major effect on the level of energy expenditure seen in these patients.