The severe head-injured patient represents a unique nutritional challenge for clinicians involved in their care. These patients are often hypermetabolic and hyper-catabolic, resulting in the need for calorie- and protein-dense feedings. Given the hormonal, metabolic, and fluid and electrolyte abnormalities that often accompany this injury, designing an optimal feeding regimen to meet these needs is difficult. A variety of feeding modalities have been studied. Total parenteral nutrition or nasogastric tube feedings are usually initiated when the patient is hemodynamically stable. Nasogastric tube feedings may be poorly tolerated. Small bowel feedings may improve tube feeding tolerance and allow the earlier initiation of enteral nutrition support. This case report describes the clinical course and nutritional support of a severe head-injured patient.
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