Head injury is characterized by both the direct injury to the brain and the overall systemic response to the brain injury. The systemic response usually includes an increase in energy expenditure, which can be quantitated by using indirect calorimetry, increased urinary nitrogen excretion, hyperglycemia, hypoalbuminemia, and elevated liver function tests. The mechanism for this hypermetabolism is probably multifactorial and includes the release of mediators in response to the injury (eg, catecholamines, cytokines), steroid therapy, nutrient administration and intercurrent complications, eg, infection. The nutritional management of the patient remains controversial. The issues that have been and that continue to be investigated are the amount and type of nutrients that will optimally allow for nerve regeneration and the optimal route of nutrient administration—enteral versus parenteral. This article reviews the proposed mechanisms for the metabolic response to head injury and the experience with nutritional support in this patient population.
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