Education

1. GENERAL SURGERY
METABOLIC RESPONSE TO TRAUMA
ASSIST. PROF. Dr. LUTFI GHULAM AWAZLI
Consultant General Surgery and Cosmetic Laser Surgery
University of Baghdad
College of Dentistry
20123 - 2024

2. Definition:
 Metabolic response to trauma
 It is a natural physiological metabolic response (Stress response) of the body
to any kind of injury (i.e. Trauma, Burn, Surgery, Infection, Bleeding, Shock).
 It includes a set of complex metabolic changes mediated by various neural
and hormonal reflexes ( Neuroendocrine reflexes) that takes place after
injury.
 It occurs to reduce the effect of injury and return the body into the
preinjury state.

3. 2) Endocrine response ( reflex)
1. Pituitary gland: GH, ACTH, ADH
2. Adrenal glands: Cortisol, Aldosterone,
.Adrenaline
3. Pancreas: Glucagon, Insulin
4. Kidneys: Renin - Angiotensin system
5. Thyroid glands: T4
1) Neural response ( reflex )
(Sympathetic activation):
Catecholamine(Adrenaline, Nor Ad)
Vasoconstriction, Increase HR.
What are the neuroendocrine response (reflex) to trauma?

4. Metabolic response to trauma
Injury
Neural
reflexes
Hormonal
reflexes

5. Metabolic response to trauma

6. Metabolic response to trauma

7. The metabolic response to trauma in humans has been defined in
3 phases:
1) Ebb phase ( or Early shock phase)
2) Flow phase ( or Catabolic phase ) ….. Early Flow phase
3) Anabolic phase ( or Recovery phase ) … Late Flow phase
x
24–48 hours 7 days 2-4 weeks
phase
x

8. Metabolic response to trauma
Injury
Basal metabolic rate

9. 1) Ebb phase or early shock phase:
 The ebb phase is the initial post-traumatic period occurs immediately after
trauma and lasts for approximately 24–48 hours (Short phase).
 The ebb phase is characterized by:
 Basal metabolic rate (BMR)
 Cardiac output, Blood pressure ( Hypovolaemia)
 Tissue perfusion, Oxygen consumption
 Body temperature (Hypothermia )
 . Decreased insulin, Glucagon (Glucose )
 Heart rate, Respiratory rate
 Lactic acidosis
 Peripheral Vasoconstriction
 The main physiological role of the ebb phase is to conserve circulating
volume and decrease energy expenditure (BMR) to conserve energy for
recovery and repair.

10. Hypothermia
Hyperglycemia
Acidosis

11.  The flow phase starts after the Ebb phase and lasts approximately 7 days.
During the catabolic phase, the increased production of :
 Hormones (i.e. Catecholamines, Cortisol, and Glucagon, Aldosterone) and
 Inflammatory cytokines (IL-1, IL-6, TNF-ά) results in:
 Significant fat and protein breakdown
 Negative nitrogen balance
 Significant weight loss.
 The flow phase is Characterized by:
 Basal metabolic rate (hypermetabolism)
 Fluid retention and tissue oedema (from
salts and water retention) due to
Aldosterone and ADH ).
 Cardiac output
 Body temperature ( Hyperthermia )
 Oxygen consumption
 gluconeogenesis. Glucagon

12. N or

13.  The Anabolic phase (Recovery phase), may last for 2 - 4 weeks.
The main physiological role of the anabolic phase is to replace the loss and
return the body into the preinjury state.
 The fat and protein store restored
 Positive nitrogen balance
 Weight gain..
3) Anabolic phase (or Recovery phase) :
 The Anabolic phase is Characterized by:
 Decrease Catecholamine
 Decrease glucagon (protein anabolism)
 Decrease gluconeogenesis
 Decrease aldosterone and ADH (Salts
and water loss)
 Cytokines reduction.
 Increase insulin

14. The differences between Ebb phase and Flow phase
Ebb phase / Early shock phase Flow phase / Catabolic phase
1. Early: Immediate post-traumatic phase
Shock phase last for (24-48 hrs.)
2. Decreased energy expenditure(BMR )
( i.e. Hypometabolic)
3. Hypothermia
4. Poor tissue perfusion
5. Decreased O2 consumption
6. Increased blood lactate level (Acidosis)
7. Mild Protein breakdown
8. Increased Catecholamine
9. Increased Glucocorticoids
10. Low Insulin
11. Increased Blood glucose level
12. Increased free fatty acid level
13. Hormones: Catecholamines, Cortisol,
Glucagon, Aldosterone, (Insulin ).
1. Later : Start after ebb phase.
Catabolic phase last for 7 days
2. Increased energy expenditure (BMR )
( i.e. Hypermetabolic)
3. Hyperthermia
4. Normal tissue perfusion
5. Increased O2 consumption
6. Normal blood lactate level
7. Profound Protein breakdown
8. Normal or increased Catecholamine
9. Normal Glucocorticoids
10. Normal or Increased Insulin
11. Normal or Increased Blood glucose level
12. Normal or Increased free fatty acid level
13. Hormones: Catecholamines, Cortisol,
Glucagon, (Insulin N or ), GH.

15. THE END