Metabolism and Nutrition in Trauma

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i a l t o understand t h i s when planning t h e n u t r i t i o n f o r t h e s e t y p e s of p a t i e n t s .The t y p i c a l metabolic response t o trauma can be summarized i n t h e following p o i n t s :1 .Increased energy expenditure.2. Increased e x t r a c e l l u l a r water and sodium r e t e n t i o n . Accelerated gluconeogenesis . Increased l i p o l y s i s .5. Increased n i t r o g e n e x c r e t i o n .6. Changes i n t h e plasma and muscle amino a c i d p a t t e r n and i n t e r o r g a n amino a c i d flow.7. Decreased muscle p r o t e i n s y n t h e s i s .It i s n o t clear what i n i t i a t e s t h e s e metabolic changes, b u t t h e hypothalamus and t h e adrenergo-sympathetic system probably p l a y very important roles.The c a t a b o l i c hormones catecholamines, glucagon and c o r t i s o l c a n p a r t l y reproduce some o f t h e s e changes when g i v e n a s a t r i p l e hormone i n f u s i o n t o a n i m a l s and h e a l t h y s u b j e c t s (16,19,29,41,43,44,53).A change i n t h e i n t e r o r g a n s u b s t r a t e f l o w s h a s been demonstrated, and a l s o increased glucose consumption and prod u c t i o n , with an increased glucose pool.Another mechanism i s t h e release of d i f f e r e n t polypeptides from macrophages, c a l l e d monokines, which have o t h e r metabolic e f f e c t s t h a n catecholamines.