Nutritional assessment and initiation of nutritional support for the head-injured patient should occur within the first few days following injury, when the patient is unable to take nutrition orally. Metabolic response after head injury indicates a hypermetabolic and catabolic state that manifests itself in increased energy expenditure and nitrogen excretion. The relationship of nutritional support to the prognosis of head-injured patients is not clear. The superiority of parenteral as opposed to enteral nutrition after head trauma is inconclusive. Advantages and possible complications of both parenteral and enteral nutrition are discussed. Nutritional management based on available studies is presented. The best approach to nutritional care of the head-injured patient involves recognition of the hypermetabolic and catabolic condition and introduction of protein and calorie provisions at the earliest possible time after injury.
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