Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

Click here to sign up for SAGE Journal Email Alerts today!

Sign In to gain access to subscriptions and/or personal tools.
Journal of Parenteral and Enteral Nutrition
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Mehta, N. M.
Right arrow Articles by Duggan, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Mehta, N. M.
Right arrow Articles by Duggan, C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Case Reports

Severe Weight Loss and Hypermetabolic Paroxysmal Dysautonomia Following Hypoxic Ischemic Brain Injury: The Role of Indirect Calorimetry in the Intensive Care Unit

Nilesh M. Mehta, MD, DCH1, Lori J. Bechard, MEd, RD, LDN2, Kristen Leavitt, RD, LDN2 and Christopher Duggan, MD, MPH2

From the 1 Division of Critical Care Medicine and2 Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.

Address correspondence to: Christopher Duggan, MD, MPH, Clinical Nutrition Service, Division of GI/Nutrition, Children's Hospital, Boston, 300 Longwood Avenue, Boston, MA 02115; e-mail: christopher.duggan{at}childrens.harvard.edu.

A 14-year-old girl with hypoxic ischemic brain injury developed multiple paroxysms (storms) of dysautonomia. She had a dramatic weight loss of 20 kg over 8 weeks. Resting energy expenditure measured by indirect calorimetry during an autonomic storm was 309% of predicted resting energy expenditure, indicating extreme hypermetabolism. Energy intake and expenditure calculations showed cumulative energy deficits during the period of weight loss. The frequency of her hypermetabolic events increased daily energy needs that were unmatched by her intake, which was calculated from standard equations. Weight stabilized soon after nutrient intake was titrated to account for her heightened energy expenditure. This case illustrates an important nutrition complication of dysautonomic storms in children with brain injury. Regular weight checks during the intensive care course allow detection of weight loss from underfeeding. Measurement of energy needs is prudent when weight loss is unexplained or increased energy expenditure is suspected. In hospitalized patients with metabolic fluctuations, accurate measurement of energy requirements by indirect calorimetry allows serial monitoring of energy balance and may guide nutrition intake to prevent cumulative energy deficits.

Key Words: dysautonomia • hypermetabolism • indirect calorimetry • brain injury • pediatric intensive care units • nutrition • parenteral nutrition

Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 3, 281-284 (2008)
DOI: 10.1177/0148607108316196
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Nutr Clin PractHome page
N. M. Mehta
Approach to Enteral Feeding in the PICU
Nutr Clin Pract, June 1, 2009; 24(3): 377 - 387.
[Abstract] [Full Text] [PDF]

Home page
 JPEN J Parenter Enteral NutrHome page
N. M. Mehta, L. J. Bechard, K. Leavitt, and C. Duggan
Cumulative Energy Imbalance in the Pediatric Intensive Care Unit: Role of Targeted Indirect Calorimetry
JPEN J Parenter Enteral Nutr, May 1, 2009; 33(3): 336 - 344.
[Abstract] [Full Text] [PDF]