METABOLISM FOLLOWING INJURY

Initial hours following injury

Reduced total body energy expenditure Urinary nitrogen wasting Upon stabilization- reprioritization of substrate utilization to preserve vital organ function and to repair injured tissue

Metabolism following injury

Magnitude of metabolic expenditure directly proportional to severity of insult Increase in energy expenditure mediated by sympathetic activation and cathecolamine release

Lipid metabolism
Potentially influences the structural integrity of cell membranes & immune response Adipose stores: predominant energy source Fat mobilization: response to cathecolamine stimulus of hormonesensitive triglyceride lipase

Lipid metabolism:
Other influences on lipolysis
Hormones ACTH Cathecolamines Thyroid hormone Cortisol Glucagon Growth hormone Reduction in insulin levels Increased sympathetic stimulus

Carbohydrate metabolism
Centered on glucose utilization Injury and severe infection: acutely induce a state of peripheral glucose intolerance May be due to reduced skeletal muscle pruvate dehydrogenase activity following injury diminishes conversion of pyruvate to acetyl CoA and subsequent entry into the TCA cycle

Carbohydrate metabolism
Increase in plasma glucose levels is proportional to the severity of injury Net hepatic gluconeogenic response believed to be under the influence of glucagon

Protein and Amino Acid metabolism

Initial systemic proteolysis following injury, mediated by glucocorticoids, increases urinary nitrogen excretion Corresponds to loss of lean body mass of about 1.5% per day = 15% in 10 days Amino acids cannot be considered as long-term fuel reserve

Protein and Amino Acid metabolism

Protein catabolism provides substrates for gluconeogenesis & for synthesis of acute phase proteins Skeletal muscles are preferentially depleted acutely following injury Visceral tissues remain preserved Accelerated urea excretion: excretion of intracellular elements (S,P,K,Mg,creatinine)

Protein and Amino Acid metabolism

Activation of ubiquitin-proteosome system in muscle cells: 1 of major pathways for protein degradation Accentuated by tissue hypoxia, acidosis, insulin resistance & elevated glucocorticoids