Metabolic requirements in tetanus.

OBJECTIVE

To measure the metabolic requirements of patients with severe tetanus who require mechanical ventilation.

DESIGN

Prospective, consecutive, open study using routine monitoring.

SETTING

A multidisciplinary ICU in a large teaching hospital.

PATIENTS: Five consecutive patients (age range 30 to 54 yrs) with severe tetanus. Four patients had clinical evidence of sympathetic nervous system overactivity.

INTERVENTIONS: All patients were mechanically ventilated and appropriately treated for severe tetanus. Sympathetic nervous system overactivity was reduced by the administration of sedatives.

MEASUREMENTS AND MAIN

RESULTS

Measurements of metabolic rates were made using an indirect calorimetry device. Each of the five patients had three 8-hr periods of continuous metabolic monitoring for each of three levels of daily enteral nutritional support. The measured metabolic rates varied from 1310 to 2050 kcal/24 hrs (predicted 1280 to 1770 kcal/24 hrs). The variations from predicted basal metabolic rates varied from -6.3% to +10.5%.

CONCLUSIONS

The measured metabolic rates of patients with severe tetanus who are appropriately sedated are relatively constant and are within 10.5% of the predicted basal metabolic rates.