Define the Nutrient Requirements during Trauma?
Nutritional assessment of the trauma patient is done to determine energy and protein requirements. Basal energy requirements are determined from standard tables based on age, sex and body surface area. These requirements are adjusted for increase in metabolic rate due to injury or disease. Dietary protein is required in greater amounts to achieve nitrogen balance. Approximately, 15 to 20% of calorie intake should be from protein. Carbohydrates (glucose) should provide 60% of caloric needs and the rest of energy needs should be met by fat. Multivitamins are given daily along with supplements of vitamin C, which is required in increased amounts after injury. Electrolytes may be added to feed formulas so as to maintain normal serum levels. Potassium, magnesium and phosphate supplements are added to parenteral fluids.
Zinc supplements should be given to severely malnourished patients or those with a history of poor nutrient intake, e.g. alcoholics. The routes of nutrition support are oral, enteral and parenteral. Oral and enteral routes are generally preferred over the parenteral (intravenous) administration. Oral liquid supplements should be administered to increase the nutrient intake. The patient's injuries may interfere with oral feedings. -Patients with facial and head injuries, disorders of the jaw, mouth or oesophagus and those receiving artificial veritilation are not able to take feeds orally. Such patients have to be fed by use of tubes. Enteral or parenteral tube feed formulas are usually balanced mixtures of fat, carbohydrate and protein. Intravenous or parenteral feedings may be necessary to supplement enteral feedings or when enteral feeds cannot be tolerated.