Initial Effect of Injury on Ketone Bodies and Other Blood Metabolites

Smith, Robin; Fuller, David; Wedge, J. H.; Williamson, D.; Alberti, K.G.G.M.

doi:10.1016/s0140-6736(75)92369-7

Cited by 72 publications

(17 citation statements)

References 16 publications

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“…The few reports available on the effect of injury on fat metabolism in man indicate that plasma [non-esterified fatty acids] is raised after trauma (McNamara, Molot, Dunn, Burran & Stremple, 1972;Meguid et al, 1974;Smith et al, 1975). However, the relationship between the plasma concentrations of the products of lipolysis and severity was not striking, although there was no reason to think that the stimulus for lipolysis was not greatest in the severely injured patients.…”

Section: Discussionmentioning

confidence: 99%

“…There has recently been much interest in the metabolism of ketone bodies after injury (Barton, 1971;Smith et al, 1975;Wedge, de Campos, Kerr, Smith, Farrell, Ilic & Williamson, 1976). Smith et al (1975) found that injured patients could be divided into groups with blood [total ketone bodies] below and above 0 -2 mmol/l, the former probably being more severely injured than the latter (Wedge et al, 1976;Williamson & Smith, 1979).…”

Section: Discussionmentioning

confidence: 99%

“…Smith et al (1975) found that injured patients could be divided into groups with blood [total ketone bodies] below and above 0 -2 mmol/l, the former probably being more severely injured than the latter (Wedge et al, 1976;Williamson & Smith, 1979). Our results showed no such clear distinction but confirmed that hyperketonaemia is less frequent in severely injured patients than in those with moderate injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Army, 1952) and pregnant women (Murdoch, 1953), or to specific injuries, such as burns (Taylor, Levenson & Adams, 1944). Interest in the substrate and hormone changes after injury has now widened (Meguid, Brennan, Aoki, Muller, Ball & Moore, 1974;Smith, Fuller, Wedge, Williamson & Alberti, 1975; Batstone, Alberti, Hinks, Smythe, Laing, Ward, Ely & Bloom, 1976), and analytical methods have improved.…”

Section: Introductionmentioning

confidence: 99%

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The Relationships between Plasma Substrates and Hormones and the Severity of Injury in 277 Recently Injured Patients

et al. 1979

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1. The plasma concentrations of glucose, lactate, amino acids, non-esterified fatty acids, glycerof, ketone bodies, ethanol, cortisol and insulin were measured in patients withii a few hours of injury and before treatment.' The severity of the injuries was assessed by the Injury Severity Score (ISS) method.2. Plasma lactate and glucose concentrations both rose significantly with increasing ISS.3. The concentrations of non-esterified fatty acids and glycerol were greater after moderate (ISS 7-12) than after minor (ISS 1-6) injuries. The glycerol concentrations were no higher and the non-esteritied fatty acid concentrations were lower after severe (ISS > 12) than after moderate injuries. The concentrations of total ketone bodies tended to follow those of non-esterified fatty acids and there was a highly significant correlation between them. 4. The total concentration of amino acids was not affected by the severity of injury and there were no systematic changes in the concentrations of individual ones. 5. Plasma insulin concentrations were very variable and not related to severity. A weak correlation with the plasma glucose concentration seen after minor and moderate injuries was lost in the severely injured. Correspondence: Professor H. B. Stoner, MRC Trauma Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, U.K.6. The plasma cortisd concentration was positively related to ISS up to ISS 12 but negativeIy so in the severely injured.7. Factors such as age, sex and time after last meal were investigated. The most important factor modifying the response was intake of ethanol, which reduced the plasma concentrations of glucose, non-esterilied fatty acids and alanine and raised that of lactate as well as the hydroxybutyratel/LacetoacetateI ratio,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Relationships between Plasma Substrates and Hormones and the Severity of Injury in 277 Recently Injured Patients

et al. 1979

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“…In injured patients, the ala nine flow from peripheral muscle to liver increases remarkably, resulting in increased ureagenesis and urine urea excretion [10,11], Smith et al [12] found that plasma ala nine concentration and urinary nitrogen ex cretion were decreased in hyperketonemic traumatized patients as compared to those without hyperketonemia. However, the vari ation in the severity of injury is an unavoid able and difficult problem in such a research.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sodium <i>D</i>-3-Hydroxybutyrate on Amino Acidemia in Hemorrhagic Hypotension

Hiraide

Katayama²,

Mizobata³

et al. 1991

Eur Surg Res

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The effect of sodium D-3-hydroxybutyrate (3-OHB) on the amino acidemia caused by hemorrhagic stress was studied. Rats were infused 3-OHB (3-OHB group, n = 11) at a rate of 30 µmol/min·kg or the same volume of saline (control group, n = 11) for 1 h prior to hemorrhage. Mean arterial pressure was maintained at 40 mm Hg using reserved bottle for 30 min. While ketosis was suppressed in control group, plasma ketone body concentration increased from 2,062.9 ± 223.7 to 3,151.4 ± 794.8 µmol/l in the 3-OHB group during hemorrhage. Although significant difference in plasma concentrations of amino acids were not shown between two groups at the onset of shock, it was shown after 30 min of shock in alanine, proline, and threonine. Particularly severity of hyperalaninemia was clear. In the control group plasma alanine concentration increased as shock proceeded (p < 0.01), and no significant change was shown in the 3-OHB group. These results indicate that pretreatment with 3-OHB suppress the hyperalaninemia seen in hemorrhagic hypotension. Ketone body administration may inhibit the protein catabolism in stressed states, such as hemorrhagic hypotension.

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The Care of the Diabetic Patient During Surgery

Gill

Alberti

2004

International Textbook of Diabetes Mellitus

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Most diabetic patients will require surgery at some time in their lives, and this presents problems for glycemic control. Surgery involves a period of starvation, and also the metabolic response to trauma includes counterregulatory hormone hypersecretion (e.g., adrenaline, cortisol, etc.), which opposes insulin action. The major factor influencing the management of diabetes during surgery is assessment of the patient's insulin reserves. Thus, those on insulin treatment (whether they are true type 1, or insulin‐treated type 2 patients) should be assumed to have little or no endogenous insulin reserves, and a system of continuous insulin and glucose delivery is necessary. Those not on insulin, however, clearly have their own insulin reserves and, provided they have reasonable preoperative glycemic control, for all but major surgery simple glycemic observation is usually all that is needed. Delivery of insulin and glucose may be by “separate lines” (intravenous (IV) glucose infusion with a separate IV insulin pump), or by a combined glucose–potassium–insulin infusion. The latter is easier to manage on lower‐staffed general wards, and the former is particularly flexible and suitable for critical care situations with more metabolically unstable patients and higher levels of staffing. Whichever system is used, patients must have regular blood glucose and plasma electrolyte monitoring, with appropriate insulin adjustments to maintain good glycemic control. With good preoperative control and assessment, and well organized and appropriate perioperative management, the risks of surgery in diabetic patients should in most cases be similar to nondiabetic rates.

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Initial Effect of Injury on Ketone Bodies and Other Blood Metabolites

Cited by 72 publications

References 16 publications

The Relationships between Plasma Substrates and Hormones and the Severity of Injury in 277 Recently Injured Patients

The Relationships between Plasma Substrates and Hormones and the Severity of Injury in 277 Recently Injured Patients

Effect of Sodium <i>D</i>-3-Hydroxybutyrate on Amino Acidemia in Hemorrhagic Hypotension

The Care of the Diabetic Patient During Surgery

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