Nutrition in the post-traumatic period.

Abstract

The early depression of metabolism, local and general, immediately following injury other than mild trauma – ‘the ebb phase’ – lasts some hours. It is then generally followed by a period of enhanced heat production and the early hyperglycaemía gives way to an excess of protein catabolism over anabolism which is more general than local – ‘the flow phase’. These are at their height 5–8 days after injury and the excess urinary nitrogen excretion is paralleled by increases in urinary sulphur, phosphorus, potassium, magnesium, zinc and creatine. Hospitalisation in a warm (28–30 °C) and relatively dry environment will reduce this excessive catabolism. Where there is inability to ingest, digest or absorb sufficient food over a period of several days and the patient’s condition is likely to deteriorate, then recourse must be made to intraduodenal or jejunal feeding or to parenteral feeding. The amino acid requirements for replacement of haemoglobin if it has not been done through appropriate transfusion can be particularly demanding in respect of certain amino acids. Obviously the non-amino acid sources of energy, as well as the other nutrients, should be suitable for the optimal utilisation of the infused amino acids.