The response to spinal cord injury (SCI) occurs in phases with an initial phase of muscle flaccidity and absence of spontaneous skeletal muscle function followed by a chronic phase where muscles become hyperexcitable and spastic. The eventual course after SCI depends on the extent of neural damage. Nutritional assessment presents a particular challenge in this patient population because essentially all of the traditional markers are effected by the SCI. Therefore, the use of anthropometric measurements, biochemical markers, and functional markers requires reinterpretation in this setting. Nutritional management is a further challenge because of alterations in appetite, gastrointestinal dysfunction, and possible pancreatitis. Metabolic changes include altered energy and nitrogen metabolism, hypercalcemia, hyponatremia, and initial weight loss followed by later weight gain. This review summarizes the unique nutritional problems that patients with SCI present and guidelines for nutritionally supporting the patient in both the acute and chronic phases.
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