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Metabolic response to trauma









maintenance of blood volume; catecholamines   

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

Catecholamines, Cortisol, Aldosterone   







3-10 days

maintenance of energy   

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

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


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.

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