The metabolic response and problems with nutritional support in acute tetanus

S. J D O'Keefe, A. Wesley, I. Jialal, S. Epstein

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Thirteen patients with severe tetanus were studied in the first and second week of illness in order to assess metabolic changes and nutritional requirements. Nine required muscular paralysis and subsequent assisted ventilation in order to control spasms. Symptoms and signs of sympathetic overactivity were especially common in the latter groups with a fourfold increase in urinary adrenaline and noradrenaline excretion. Other hormonal and metabolic abnormalities included hyperglycemia, mildly elevated insulin concentrations with no significant rise in cortisol, and glucagon. Evidence of excessive protein catabolism was obtained particularly during the second week of illness, mean urinary nitrogen excretion being 20.5 ± 13.8 g/d. Maintenance of nutrient homeostasis proved impossible with conventional enteral-feeding techniques: high-density feeds exacerbated hyperglycemia and diarrhea; low-density feeds were unable to maintain nitrogen balance (-12.34 g/d in ventilated patients, second week). The results indicate that loss of lean body mass is inevitable in such patients unless the metabolic response can be suppressed or more aggressive forms of nutritional support (eg, total parenteral nutrition including sufficient insulin to maintain normoglycemia) are employed.

Original languageEnglish (US)
Pages (from-to)482-487
Number of pages6
JournalMetabolism
Volume33
Issue number5
DOIs
StatePublished - 1984
Externally publishedYes

Fingerprint

Nutritional Support
Tetanus
Hyperglycemia
Nitrogen
Insulin
Nutritional Requirements
Total Parenteral Nutrition
Spasm
Enteral Nutrition
Glucagon
Paralysis
Epinephrine
Signs and Symptoms
Ventilation
Hydrocortisone
Diarrhea
Norepinephrine
Homeostasis
Maintenance
Food

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

The metabolic response and problems with nutritional support in acute tetanus. / O'Keefe, S. J D; Wesley, A.; Jialal, I.; Epstein, S.

In: Metabolism, Vol. 33, No. 5, 1984, p. 482-487.

Research output: Contribution to journalArticle

O'Keefe, SJD, Wesley, A, Jialal, I & Epstein, S 1984, 'The metabolic response and problems with nutritional support in acute tetanus', Metabolism, vol. 33, no. 5, pp. 482-487. https://doi.org/10.1016/0026-0495(84)90152-5
O'Keefe, S. J D ; Wesley, A. ; Jialal, I. ; Epstein, S. / The metabolic response and problems with nutritional support in acute tetanus. In: Metabolism. 1984 ; Vol. 33, No. 5. pp. 482-487.
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