A Prospective Evaluation of Nutritional Outcomes After Acute Spinal Cord Injury

Abstract

Six patients admitted to our institution with complete traumatic quadriplegia were studied for up to 4 weeks post injury to determine the effect of individualized nutritional support on nitrogen balance and visceral protein synthesis. Energy expenditure was estimated using the Harris Benedict equation multiplied by an activity and injury factor upon initial assessment. Protein need was estimated at 2.0 gm/kg or 0.23 gm nitrogen/kg/actual body weight/day. Mean 24 hour total energy expenditure (TEE) and respiratory quotient (RQ) measurements were obtained utilizing the Puritan Bennett 7250 Metabolic Monitor between post injury days #3-7 and were repeated weekly for up to 4 weeks. All patients received continuous enteral support based upon the initial predicted requirements; support was then evaluated and modified considering TEE and RQ after each 24 hour measurement. Nitrogen balance and serum prealbumin (PAB) were obtained weekly. Poor tolerance to gastric administration of enteral formula frequently precluded rapid achievement of target enteral support. However, all patients eventually received ≥100% of measured TEE with significant improvement noted between initial and final energy (p=0.014) and protein (p=0.025) delivery. Mean nitrogen balance was less negative (mean−10 g/d vs −4.6 g/d p=NS) over the 4 week period despite a rise in the mean urine urea nitrogen excretion, while mean serum PAB levels significantly improved (mean 12.83 to 29.7 mg/dl p=0.002). Positive nutritional outcomes were realized in this patient population despite the observed catabolic processes.