Metabolic Disorders in Paraplegics

Abstract

300 paraplegics were studied. After any acute injury to the spinal cord sufficient to cause paraplegia there is a marked catabolism of body protein. Invariably a negative N balance is present for 2 weeks. Although, in most cases a normal N balance is reestablished 8 or 10 weeks after injury, in some instances a negative balance may persist as long as 14 mos. after the original injury. The mechanism responsible for this is not known. There is some liver impairment as measured by the bromsulfalein liver function test. This spontaneously resolves in 8-10 weeks and is not found in chronic cases although hepatomegaly and amyloidosis was reported. The basal metabolic rate is usually decreased, although the protein-bound I and blood cholesterol values were normal. The immobilization of the extremities may contribute to the lowered O2 consumption. Gynecomastia develops in 20% of the men within 3 mos. to 5 yrs. after the injury. Testosterone relieves the pain associated with this and may result in resolution of the breast hypertrophy. Testicular atrophy occurs in 50% of paraplegic males. There are also transient changes in excretion of 17-ketosteroids and a decrease of eosinophils. The early metabolic changes are possibly the combined results of the alarm reaction and spinal shock while the later ones are considered to be primarily neurogenic as a result of changes produced by transection of the spinal cord.