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Pediatric Traumatic Brain Injury: Metabolic Stress with Nutr

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Eloisa Mena

on 21 April 2014

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Transcript of Pediatric Traumatic Brain Injury: Metabolic Stress with Nutr

Chelsea Montgomery
8 y/o female admitted to the ER

Ht: 4’3” Wt: 61lbs

Car accident

Traumatic brain injury

Healthy baby-severe myopia

2nd grade student-physically active

General appearance: crying and unconsiousness
GCS=10 E4V2M4


L-sided hemiparesis

No verbal responses

2cm laceration on R knee-DTR symmetric

Withdrawal and moaning when touched

Lost 11lbs in her 12 day at the hospital

Dx: Traumatic brain injury,
secondary to MVA

Frontal Lobe Injury
Metabolic Stress
Physiological effects due to trauma

Affects the major body systems in different ways
Immune system
Slows wound healing
Hypermetabolism leads to diminished muscle strength
Hormonal changes

Results in negative nitrogen balance
Energy needed increases

nitiate enteral feeding!
Recommended Nutrients
Branched- chain amino acids
Vitamin C
Vitamin E
More about Chelsea...
Pediatric Traumatic Brain Injury:
Metabolic Stress with Nutrition Support

Case 28
Eloisa Mena
HNDS 567

Cerebral Edema
General Functions:
Motor Skills
Eye Coordination
Decision-making Skills
Problem solving
Long-term effects:
Attention span
Specific Concerns for Registered Dietitian
Vital period in a child's life
Maintain regular growth pattern
Getting proper amount of energy and protein for her to heal quickly
Getting back on regular, oral diet
Pediasure 1.5 at a goal rate of 57 cc/hr
Serving Size: 8 fl oz (237 mL)
(1.5 kcal/cc)(57 cc/hr)(24 hr/day)=
2052 kcal/day

(14g pro/237cc)(57 cc/hr)(24 hr/day)=
80.8g protein
These values exceed her needs.
Abnormal Lab Values
Glucose levels (mg/dL) 70-110 145
Bilirubin (mg/dL) <0.3 0.8
Alkaline phosphatase (U/L) 30-120 138
Lactate (mmol/L) <1.00 2.1
Fibrinogen (mg/dL) 160-450 472
C-reactive protein (Meq/L) 0.3-2.3 2.5

Protein (g/dL) 6-8 5.1
Albumin (g/dL) 3.5-5 2.8
Urine Sample
Total urine urea nitrogen: 12g
Nitrogen Balance: -4.9

Negative nitrogen balance is normal in TBI patients
Nitrogen loss can contributed to:
high levels of epinephrine, norepinephrine, glucagon
PES Statements
Swallowing difficulty (NC-1.1) related to neurological damage to the frontal lobe as evidenced by radiology and failed speech/ swallowing evaluation.

Unintentional weight loss (NC-3.2) related to decrease ability to consume sufficient energy as evidenced by a weight loss of 10 pounds in 12 days.
PO Mechanical Soft Diet
Occupational Therapist: Regain ability perform daily activities

Speech Therapist: Help with speaking and swallowing

Physical Therapist: Improve movement and manage pain from the injuries

Ref. Range
Chelsea's Requirements
EER: 88.5-61.9 X 8 + 1.31 X (10X27.7+903 X 1.3) + 20 =
1514 kcal

Protein: 1.5g/kg - 2.0g/kg X 27.7kg=
42-52g of PRO

Thank you!
Chelsea's Requirements with TBI
140% of Chelsea's usual EER:
2120 kcal/day

PRO 2.0-2.5 kg/day
54-68g PRO

Ensure she gets her prescribed nutrition!
Continuous vs. Intermittent feeding
Full transcript