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Pediatric Traumatic Brain Injury: Metabolic Stress with Nutr
Transcript of Pediatric Traumatic Brain Injury: Metabolic Stress with Nutr
8 y/o female admitted to the ER
Ht: 4’3” Wt: 61lbs
Traumatic brain injury
Healthy baby-severe myopia
2nd grade student-physically active
General appearance: crying and unconsiousness
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
Physiological effects due to trauma
Affects the major body systems in different ways
Slows wound healing
Hypermetabolism leads to diminished muscle strength
Results in negative nitrogen balance
Energy needed increases
nitiate enteral feeding!
Branched- chain amino acids
More about Chelsea...
Pediatric Traumatic Brain Injury:
Metabolic Stress with Nutrition Support
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)=
(14g pro/237cc)(57 cc/hr)(24 hr/day)=
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
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
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
EER: 88.5-61.9 X 8 + 1.31 X (10X27.7+903 X 1.3) + 20 =
Protein: 1.5g/kg - 2.0g/kg X 27.7kg=
42-52g of PRO
Chelsea's Requirements with TBI
140% of Chelsea's usual EER:
PRO 2.0-2.5 kg/day
Ensure she gets her prescribed nutrition!
Continuous vs. Intermittent feeding