Post-shock metabolic response is characterized by the two aspects of metabolic stress response: burden in the form of increased energy expenditure and protein breakdown that results to muscle breakdown. Interestingly, a negative protein balance until 9 months after injury occurs with erosion of lean body mass.
The pragmatic approach to managing these acutely traumatized patients is to individualize energy and protein prescription. Early enteral nutrition should be initiated within 24-48 hours after admission. Conversely, there is no role for early parenteral nutrition within the first few days. Early mobilization, physical therapy and pharmacotherapy are emerging methods of improving functional outcomes.