Steroid administration and nitrogen excretion in the head-injured patient

The effect of steroid administration on metabolic rate and nitrogen excretion was examined in 20 head-injured patients alternately assigned to receive either methylprednisolone for 14 days or no steroid treatment. Although metabolic rate, caloric intake, and nitrogen intake were not different between the two groups, the patients who received steroids had a 30% higher excretion of nitrogen during the first 6 days after injury than did the patients not receiving steroids. All patients had an increase in nitrogen excretion through the 2nd week, peaking on Day 11. By Day 21 after injury, the patients had an average cumulative nitrogen loss of 162 gm and had lost an average of 5 kg body weight regardless of whether they had received steroids. Serum albumin levels decreased in the steroid-treated patients but returned to nearly normal by Day 21 in the untreated group. Immunosuppression, evidenced by a lower initial total lymphocyte count and a higher incidence of infections, was present in the steroid group; hyperglycemia requiring insulin treatment was more common in those patients.