METABOLIC DERANGEMENTS IN SEPSIS AND SEPTIC SHOCK
2000; Elsevier BV; Volume: 16; Issue: 2 Linguagem: Inglês
10.1016/s0749-0704(05)70112-3
ISSN1557-8232
Autores Tópico(s)Electrolyte and hormonal disorders
ResumoIn 1942, Sir David Cuthbertson introduced the terms ebb and flow to describe the phases of hypo- and hypermetabolism that follow traumatic injury. 22 Cuthbertson D.P. Post-shock metabolic response. Lancet. 1942; 1: 433 Abstract Scopus (272) Google Scholar This nomenclature also has been applied to sepsis and septic shock; however, the onset of the ebb phase in sepsis is less clearly defined when compared with trauma because of the presence of a septic “preshock” period during which certain alterations in normal metabolism occur. 65 Mizock B. Septic shock: A metabolic perspective. Arch Intern Med. 1984; 144: 579 Crossref PubMed Scopus (44) Google Scholar The ebb phase begins immediately after injury and is characterized by tissue hypoperfusion, vasoconstriction, and a decrease in overall metabolic activity. Hyperglycemia may be seen during the ebb phase. In patients with trauma, the degree of hyperglycemia parallels the severity of injury; it is promoted by hepatic glycogenolysis secondary to catecholamine release and by direct sympathetic stimulation of glycogen breakdown. 7 Barton R.N. Neuroendocrine mobilization of body fuels after injury. Br Med Bull. 1985; 41: 218 PubMed Google Scholar , 30 Frayn K.N. Little R.A. Maycock P.F. et al. The relationship of plasma catecholamines to acute metabolic and hormonal responses to injury in man. Circ Shock. 1985; 16: 229 PubMed Google Scholar The ebb phase typically lasts 12 to 24 hours but may last longer depending on the severity of injury and the adequacy of resuscitation. The onset of the flow (catabolic) phase is signaled by the restoration of oxygen delivery and metabolic substrate. The duration of this phase depends on the severity of injury or infection and development of complications; it typically peaks around 3 to 5 days, subsides by 7 to 10 days, and merges into an anabolic phase over the next few weeks. The flow phase is characterized by a marked stimulation of metabolic activity that is associated with an increase in resting energy expenditure, oxygen consumption, cardiac output, and carbon dioxide production. Carbohydrate and fat stores are mobilized to accommodate increased energy demands; concurrent catabolism of skeletal muscle provides amino acids for gluconeogenesis and protein synthesis. This metabolic milieu promotes hyperglycemia, hyperlactatemia, hypertriglyceridemia, prerenal azotemia, and urinary nitrogen loss. 15 Cerra F.B. Hypermetabolism, organ failure, and metabolic support. Surgery. 1987; 101: 1 PubMed Google Scholar
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