The Relationships between Plasma Substrates and Hormones and the Severity of Injury in 277 Recently Injured Patients

Abstract

1. The plasma concentrations of glucose, lactate, amino acids, non-esterified fatty acids, glycerof, ketone bodies, ethanol, cortisol and insulin were measured in patients withii a few hours of injury and before treatment.' The severity of the injuries was assessed by the Injury Severity Score (ISS) method.2. Plasma lactate and glucose concentrations both rose significantly with increasing ISS.3. The concentrations of non-esterified fatty acids and glycerol were greater after moderate (ISS 7-12) than after minor (ISS 1-6) injuries. The glycerol concentrations were no higher and the non-esteritied fatty acid concentrations were lower after severe (ISS > 12) than after moderate injuries. The concentrations of total ketone bodies tended to follow those of non-esterified fatty acids and there was a highly significant correlation between them. 4. The total concentration of amino acids was not affected by the severity of injury and there were no systematic changes in the concentrations of individual ones. 5. Plasma insulin concentrations were very variable and not related to severity. A weak correlation with the plasma glucose concentration seen after minor and moderate injuries was lost in the severely injured. Correspondence: Professor H. B. Stoner, MRC Trauma Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, U.K.6. The plasma cortisd concentration was positively related to ISS up to ISS 12 but negativeIy so in the severely injured.7. Factors such as age, sex and time after last meal were investigated. The most important factor modifying the response was intake of ethanol, which reduced the plasma concentrations of glucose, non-esterilied fatty acids and alanine and raised that of lactate as well as the hydroxybutyratel/LacetoacetateI ratio,

Corticosteroid Therapy in Severe Illness

“…1B). 30,[32][33][34] The values are highest in patients with the highest illness-severity scores 3,5,7,30,[32][33][34][35] and in those with the highest mortality, 5 and the values are very high (30 to 260 m g per deciliter [828 to 7173 nmol per liter]) shortly before death. 36 Adrenal function in severely ill patients is often evaluated by a corticotropin-stimulation test, in which serum cortisol is measured at base line and 30 to 60 minutes after the intravenous administration of 250 m g of cosyntropin.…”

Postburn trauma insulin resistance and fat metabolism

“…This is because the adipocyte does not contain glycerol kinase, which is necessary to convert glycerol to glycerol phosphate, which is the backbone of newly produced TG. In trauma patients, increased glycerol concentrations, but not FFA concentrations, correlated with the severity of the injury (95). Glycerol concentrations and turnover were increased significantly 6 days following total hip replacement surgery (16).…”

“…The first phase occurs within the first 48 h from injury and has classically been called the "ebb phase" (28,111). This phase of the response appears to be related to the magnitude of the trauma and the acute response hormones, including norepinephrine, epinephrine, dopamine, glucagon, and cortisol (33,94,95,98,116). The initial rise in plasma glucose after injury is seen within 30 min in guinea pigs, 2 h in rats, and 1 h in severely burned children (23,33,116).…”

Regulation of lipid metabolism in adipose tissue

“…Lipids are the preferred fuel for oxidation in patients with sepsis (Shaw & Wolfe, 1987) and trauma (Stoner et al 1979;Wolfe et al 1987). This rise in lipid oxidation is directly attributable to the increased plasma NEFA concentration.…”