Orthoteers homepage Advertise on Orthoteers
Orthoteers Junior Orthoteers Orthopaedic Biomechanics Orthopaedic World Literature Society Educational Resources Image Gallery About Orthoteers Orthoteers Members search

Metabolic response to trauma

SUMMARY

Phase   

Duration   

Role   

Physiological   

Hormones   

Ebb   

<24hrs   

maintenance of blood volume; catecholamines   

decr. BMR, decr. Temp, decr. O2 consumption; vasoconstriction; incr. CO, incr. HR; acute phase proteins

Catecholamines, Cortisol, Aldosterone   

Flow   

   

 

   

  

Catabolic   

3-10 days

maintenance of energy   

incr. BMR, incr. Temp., incr. O2 consumption, negative nitrogen balance   

Incr. glucagon, insulin, cortisol, catecholamines - but insulin resistance   

Anabolic   

10-60 days

replacement of lost tissue   

positive nitrogen balance   

Growth hormone, IGF   

 


1. Definition of Trauma

Bodily injury is accompanied by systemic as well as local effects. Any stress, which includes injury, surgery, anaesthesia, burns, vascular occlusion, dehydration, starvation, sepsis, acute medical illness, or even severe psychological stress will initiate the metabolic response to trauma.

Following trauma, the body responds locally by inflammation and by a general response which is protective, and which conserves fluid and provides energy for repair. Proper resuscitation may attenuate the response, but will not abolish it.

The response is characterised by an acute catabolic reaction, which precedes the metabolic process of recovery and repair. This metabolic response to trauma was divided into an ebb and flow phase by Cuthbertson.

The ebb phase corresponds to the period of severe shock characterised by depression of enzymatic activity and oxygen consumption. Cardiac output is below normal, core temperature may be subnormal, and a lactic acidosis is present.

The flow phase can be divided into

  • a catabolic phase with fat and protein mobilisation associated with increased urinary nitrogen excretion and weight loss, and
  • an anabolic phase with restoration of fat and protein stores, and weight gain.

In the flow phase, the body is hypermetabolic, cardiac output and oxygen consumption are increased, and there is increased glucose production. Lactic acid may be normal.




This is a preview of the site content. To view the full text for this site, you need to log in.
If you are having problems logging in, please refer to the login help page.


© 2005-2007 Orthoteers.co.uk - last updated by Len Funk on 15 February 2005Medical Merketing and SEO by Blue Medical 
Biomet supporting orthoteersThe British Orthopedic Association supporting OrthoteersOrthoteers is a non-profit educational resource. Click here for more details
Scoring Systems & Classifications
AO Surgery Reference
Bone & Fracture Mechanics
Bone Healing Abnormalities
Compartment Syndrome
Complications
Fat Embolism: Diagnosis and Treatme...
Fracture Healing
Fractures prone to Osteonecrosis (A...
Head Injuries
Hypovolaemic shock
Metabolic response to trauma
Multiple Trauma / ATLS
Open (Compound) fractures
Physeal Fractures
Physical Abuse of Children / Non-Ac...
Plaster of Paris
Post-fracture infection
Robert Danis
Soft Tissue Trauma
Traction
Traumatology and Orthopedic surgery...
Hide Menu