Dietary management for the RTA with polytrauma

P. Snekapriya*, N. Bhuvaneshwari

Department of clinical dietitian, Kauvery hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Introduction

Polytrauma refers to multiple traumatic injuries sustained by an individual, often involving several body regions or organ systems. Treatment of this condition is focused on early diagnosis and surgical intervention. In this report, we described a case of 28 Years old male who has no previously known co-morbidities. He had alleged history of RTA with polytrauma injury.

Case Presentation

A 28-year-old male who has no previously known co-morbidities. He had alleged history of RTA with polytrauma injury on 17.03.2025. History of loss of consciousness (+). Initially took to outside hospital, on 17.03.2025 Patient referred to our hospital for further management. Patients were hemodynamically stable. CECT abdomen revealed grade IV renal injury and grade III liver injury. CT face revealed left maxillary sinus fracture with multiple facial bone fractures.

20/03/2025: Patient became restless, tachypneic and impending respiratory failure for which he was intubated and mechanically ventilated. Patient developed ARDS, Sepsis (Burk holderia), AKI (Resolved), HAP (Hospital Acquired Pneumonia).

Blood investigation was done. (HB, platelets, sodium, potassium, RFT, LFT, albumin) are to be taken. In view of persistent fever spikes, repeat cultures were sent. Bronchoscopy was done. In view of low GCS, CT brain was done, which was normal study. For prolonged ventilation we need tracheostomy.

01/04/2025 was Tracheostomy done and he was on sedation and paralysis. Patient showed gradual improvement in GCS. Patient was gradually weaned to CPAP and BIPAP trial was given and shifted to ward on 27/04/2025. Decannulation was done. Oral feeds were initiated, and patient was gradually mobilized. The patient was discharged on 03/05/2026.

Discussion

Initially patient was on NPO for observation. Next day we started oral clear liquid diet. Patient became restless, tachypneic, he was intubated and mechanically ventilated. So, we started RT feeds (Clear liquid). Patient developed ARDS with high FiO2 requirement in which he was prone ventilated. Restarted the RT feed (Artificial supplement). Patient on MNS for Tracheostomy. We reduced the feeding due to the RFT elevation. Patient tolerated RT feeding, hence we increased calories and reduced protein content. Patient had loose stools and vomiting complaints, so feeding was withheld. As the patient condition improved patient was shifted to the ward, we added kitchen feed + supplement feed in the RT feed. Patient on NPO decannulation was done. We started oral trial (Normal liquids) patient tolerated well. RT feeding was stopped and given oral high protein semi solid diet along with oral nutrition supplement. At the time of admission, the patient’s body weight was 98kg. During the hospital stay, structured nutritional intervention and medical management resulted in a weight reduction of 3.92 kg. At discharge, the patient’s weight was recorded as 94.08 kg, reflecting a total weight loss 4% from baseline. The patient was advised to follow a high protein diet.

Dietetic challenges expected in polytrauma

Hypermetabolism and Catabolism

Severe injury triggers massive energy expenditure and protein breakdown (negative nitrogen balance) that is two to three times faster than in standard starvation. This “auto cannibalism” leads to rapid skeletal muscle wasting.

  • ARDS + sepsis – severe inflammatory response.
  • Increased energy expenditure (20 – 50%).
  • Rapid muscle wasting .

High protein requirement with AKI

  • Trauma + Sepsis – increased protein needs (1.5 – 2 g /kg).
  • But AKI complicates protein prescriptions.

Mechanical Ventilation and ARDS

  • High FiO2
  • Prone ventilation.
  • Sedation and Paralysis.

Key challenges: Risk of aspiration, feeding intolerance and need for controlled carbohydrate (to reduce C02 production).

Frequent NPO Status

  • Procedures (intubation, bronchoscopy and tracheostomy).
  • Hemodynamically instability.

Enteral feeding intolerance: Loose stools and vomiting.

Fluid and electrolyte imbalance: Sepsis, AKI, IV fluid.

Infection and sepsis: Hospital acquired pneumonia, persistent fever.

Low albumin and inflammation

  • Albumin reduced due to inflammation.
  • Transition phase (weaning and oral feeding).
  • Tracheostomy, shift from rt feed to oral feeds, swallowing difficulty risk.

Result

At the time of discharge, the patient was clinically stable with improved vital parameters and adequate oral intake. Nutritional status showed gradual improvements compared to admission findings. The patient was advised to continue a high protein diet to support recovery. Promote tissue healing and prevent further muscle loss. Dietary counselling was provided.

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