December 1974

Hormone-Substrate Interrelationships Following Trauma

Author Affiliations

From the Department of Surgery, Harvard Medical School at the Peter Bent Brigham Hospital (Drs. Meguid, Brennan, and Moore and Ms. Ball), and Joslin Research Laboratory (Drs. Aoki and Muller), Boston.

Arch Surg. 1974;109(6):776-783. doi:10.1001/archsurg.1974.01360060046013

Serial blood samples were collected from 14 injured persons on admission to the hospital and at regular intervals for 24 hours. Seven of the patients had severe and seven had minor trauma. Hyperglycemia, elevated free fatty acid (FFA) levels, hypoinsulinemia, hyperglucagonemia, and elevated cortisol levels were observed in many instances. These changes were more pronounced when trauma had been more severe.

Interrelationships between the hormones and the nutritional substrates were revealed as an inappropriately low insulin level for the concomitant glucose concentration and a breakdown of the relationship of glucose to FFA. We postulate that, in trauma, the gradual rise in glucagon contributes to the increase in concentration of glucose and FFA, and that the cortisol rise synergizes with the elevated glucagon concentration to favor gluconeogenesis from muscle amino acids. Relatively low circulating insulin levels favor these metabolic changes.