Nature of the Post-shock Delayed Metabolic Response

Nature of the Post-shock Delayed Metabolic Response 

This corresponds to the flow period of returning metabolic activity following the early ebb period of depressed metabolism resulting from the injury, whether accidental or elective, and can be considered as a further phase of the inflammatory reaction. It has sometimes been described as the delayed response, but this is not a sufiiciently accurate description for it connotes that something has been held back, rather than being part of a cyclical response. Our interest in understanding this reaction and the contributions of our colleagues to it extend over a period of some 40 years and have recently been reviewed by us (C19, C20, C22-C27, C33, C34). 

The source of the nitrogen and sulfur lost by man and experimental animals has never been clearly defined, but because of its magnitude and the N S and N K ratios of the excess in the urine it must come mainly from muscle (C21, C22, C37). Munro (M17) has postulated this labile protein in man as 300-400 g, but very much larger amounts are frequently lost as a consequence of bony injury (C21). There is also evidence that in the previously depleted subject there is little response (Al), and this clinical evidence agrees with the earlier findings on animals (M4, M19, M20). 

Subsequent operations and manipulations may cause further disturbance. Even after a month there may be a slight negative balance, but normally there is a slow merging into an anabolic phase (S2). In burns loss of tissue plays a large part in the initial nitrogen depletion and this is only slowly made good nevertheless, there is a marked catabolic response (B19, C15, HU, Tl). 

More nitrogen may be eliminated in the course of 10 days following severe bony injury than is present in the whole of the liver (C21). The discharge, however, involves the liver, and we have earlier in this paper drawn attention to the effect of anoxemia on the capacity of the liver to deal with urea formation. 

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Nature of the Post-Shock Delayed Metabolic Response.19... 

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