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

1979 ◽  
Vol 56 (6) ◽  
pp. 563-573 ◽  
Author(s):  
H. B. Stoner ◽  
K. N. Frayn ◽  
R. N. Barton ◽  
C. J. Threlfall ◽  
R. A. Little
Keyword(s):  
Amino Acids ◽  
Fatty Acids ◽  
Injury Severity ◽  
Ketone Bodies ◽  
Total Concentration ◽  
Plasma Concentrations ◽  
Severely Injured ◽  
Esterified Fatty Acids ◽  
Severity Of Injury ◽  
Injured Patients

1. The plasma concentrations of glucose, lactate, amino acids, non-esterified fatty acids, glycerol, ketone bodies, ethanol, cortisol and insulin were measured in patients within 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-esterified 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. 6. The plasma cortisol concentration was positively related to ISS up to ISS 12 but negatively 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-esterified fatty acids and alanine and raised that of lactate as well as the [β-hydroxybutyrate]/[acetoacetate] ratio.

Metabolic Aspects of Hypothermia in the Elderly

1980 ◽  
Vol 59 (1) ◽  
pp. 19-27 ◽  
Author(s):  
H. B. Stoner ◽  
K. N. Frayn ◽  
R. A. Little ◽  
C. J. Threlfall ◽  
D. W. Yates ◽  
...  
Keyword(s):  
Amino Acids ◽  
Ketone Bodies ◽  
Plasma Concentrations ◽  
The Elderly ◽  
High Plasma ◽  
Active Involvement ◽  
Esterified Fatty Acids ◽  
Lipid Metabolites ◽  
High Concentrations ◽  
Very High

1. Plasma concentrations of glucose, lactate, amino acids, non-esterified fatty acids, glycerol, ketone bodies, insulin and cortisol were measured in 43 elderly patients with hypothermia. In 15 of these patients forearm arteriovenous differences were also measured. Core temperatures ranged from 25.9 to 35.5°C. 2. The metabolic state was of mobilization of glycogen and triacylglycerol stores, with high plasma concentrations of lactate and lipid metabolites. The plasma concentration of glucose was raised in those with hypothermia of a short duration (<6 h). In other patients it was low in those with core temperatures around 30°C, but below this temperature it was variable and often high. Concentrations of other metabolites or hormones were not related to core temperature. 3. Plasma concentrations of cortisol were high and positively correlated with those of lactate and glycerol, suggesting active involvement in stimulation of muscle glycogenolysis and of lipolysis. 4. Plasma concentrations of insulin ranged from very low to very high and appeared to depend on the concentrations of both glucose and alanine. 5. Arteriovenous differences were generally small. There was peripheral release of lactate and of amino acids but no overall peripheral uptake of glucose. In nine out of 15 patients there was a significant peripheral release of glucose. 6. No differences in metabolism were observed between patients where the hypothermia appeared accidental and those with an obvious precipitating illness, despite a significantly lower mortality in the former group. 7. It was concluded that therapy should primarily involve rewarming of patients by physical means, without metabolic intervention.

Plasma concentrations of glucose and non-esterified fatty acids (N.E.F.A.) in the pregnant and lactating ewe and the effect of dietary restriction

1964 ◽  
Vol 62 (2) ◽  
pp. 253-262 ◽  
Author(s):  
D. S. P. Patterson ◽  
K. N. Burns ◽  
N. F. Cunningham ◽  
C. Nancy Hebert ◽  
N. Saba
Keyword(s):  
Fatty Acids ◽  
Plasma Glucose ◽  
Ketone Bodies ◽  
Plasma Concentrations ◽  
Plasma Triglyceride ◽  
Liver Fat ◽  
Esterified Fatty Acids ◽  
Pregnancy Status ◽  
Skew Distribution ◽  
In Pregnancy

1. The effect of undernutrition on the levels of plasma glucose, N.E.F.A. and ketone bodies was observed in fourteen Suffolk-cross ewes late in pregnancy by comparing with data obtained on seven control ewes of comparable pregnancy status. An attempt is made to relate these changes with plasma triglyceride levels, liver fat deposition and plasma pigmentation.2. Evidence is presented which shows that while plasma glucose values are normally distributed, plasma N.E.F.A. levels show a positively skew distribution. This abnormality is corrected by transforming plasma N.E.F.A. values to their logarithms.

Initial Approach to the Management of Multisystem Trauma

2019 ◽  
pp. 397-401
Author(s):  
David S. Morris
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Hospital Admissions ◽  
The United States ◽  
Emergency Department Visits ◽  
Severely Injured ◽  
Level Ii ◽  
Level I ◽  
Nonfatal Injuries ◽  
Injured Patients

Nearly 200,000 people die of injury-related causes in the United States each year, and injury is the leading cause of death for all patients aged 1 to 44 years. Approximately 30 million people sustain nonfatal injuries each year, which results in about 29 million emergency department visits and 3 million hospital admissions. Management of severely injured patients, typically defined as having an Injury Severity Score greater than 15 is best managed in a level I or level II trauma center. Any physician who provides care for critically ill patients should have a basic familiarity with the fundamentals of trauma care.

Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

2014 ◽  
Vol 80 (11) ◽  
pp. 1132-1135 ◽  
Author(s):  
Peter E. Fischer ◽  
Paul D. Colavita ◽  
Gregory P. Fleming ◽  
Toan T. Huynh ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Local Trauma ◽  
Level 1 ◽  
Poor Outcomes ◽  
Injured Patients ◽  
Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

Vasopressor Use during Emergency Trauma Surgery

2014 ◽  
Vol 80 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Robert M. Van Haren ◽  
Chad M. Thorson ◽  
Evan J. Valle ◽  
Gerardo A. Guarch ◽  
Jassin M. Jouria ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mortality Rate ◽  
Odds Ratio ◽  
Injury Severity ◽  
Trauma Surgery ◽  
Vital Signs ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Vasopressor Use ◽  
Injured Patients

Most evidence suggests early vasopressor use is associated with death after trauma, but no previous study has focused on patients requiring emergency operative intervention (OR). We test the hypothesis that vasopressors are harmful in this population. Records from 746 patients requiring OR from July 2009 to March 2013 were retrospectively reviewed and stratified based on vasopressor use (epinephrine [EPI], phenylephrine, ephedrine, norepinephrine, dobutamine, vasopressin) or no vasopressor use. Vasopressors were administered to 225 patients (30%) during OR; 59 patients (8%) received multiple vasopressors. Patients who received vasopressors were older, more severely injured, had worse vital signs, and increased mortality rate (all P < 0.001). EPI was independently associated with mortality (odds ratio, 6.88; P = 0.001). If patients who received EPI were excluded, there was no difference in mortality between those who received vasopressors alone or in combination and those that did not (5 vs 6%, P = 0.523), although multiple markers of injury severity were worse. We conclude that vasopressor use is relatively common in the most severely injured patients requiring OR and is associated with mortality. EPI is most often used for cardiac arrest, whereas other vasopressors are used for their vasoconstrictive properties. This suggests that, except for EPI, vasopressors during OR are not independently associated with mortality.

“Shift Work” Improves Survival and Reduces Intensive Care Unit Use in Seriously Injured Patients

2007 ◽  
Vol 73 (2) ◽  
pp. 185-191
Author(s):  
Luke Y. Shen ◽  
Stephen D. Helmer ◽  
Jennifer Huang ◽  
Gerayu Niyakorn ◽  
R. Stephen Smith
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Shift Work ◽  
Continuity Of Care ◽  
Injury Severity ◽  
Severely Injured ◽  
Trauma Service ◽  
Injured Patients

We assessed whether a trauma service model with an emphasis on continuity of care by using “shift work” will improve trauma outcomes and cost. This was a case-control cohort study that took place at a university-affiliated Level I trauma center. All patients (n = 4283) evaluated for traumatic injuries between May 1, 2002 and April 30, 2004 were included. During Period I (May 1, 2002 to April 30, 2003), a rotating off-service team provided initial management between 5:00 PM and 7:00 AM. The “day team” provided all other care and was responsible for continuity of care. In Period II (May 1, 2003 to April 30, 2004), a dedicated trauma service consisting of two resident teams evaluated all injured patients. Variables included hospital and intensive care unit length of stay (LOS), mechanical ventilation requirements, hospital mortality, and hospital care costs. Demographics and injury mechanism for both periods were similar, but Injury Severity Score (ISS) in Period II was greater (ISS, 8.2% vs 7.2%, P < 0.0001; ISS > 15, 18.5% vs 15.4%). In the more severely injured (ISS > 15), patients in Period II had shorter hospital LOS (8.6 vs 9.7 days, P = 0.98), a shorter ICU LOS (5.5 vs 7.7 days, P = 0.039), shorter mechanical ventilator requirements (5.5 vs 7.7 days, P = 0.32), improved hospital mortality rate (19.9% vs 26.8%, P = 0.029), and decreased hospital costs ($19,146 vs $21,274, P = 0.36). On multivariate analysis, factors affecting mortality and LOS included age, initial vital signs, injury type, and ISS. Overall, the two trauma service models resulted in similar outcomes. Although multivariate analysis revealed that treatment period did not affect mortality, our study revealed improved patient survival and reduction in LOS and cost for the severely injured in Period II.

scholarly journals Metabolic consequences of methylenecyclopropylglycine poisoning in rats

1991 ◽  
Vol 274 (2) ◽  
pp. 395-400 ◽  
Author(s):  
K Melde ◽  
S Jackson ◽  
K Bartlett ◽  
H S A Sherratt ◽  
S Ghisla
Keyword(s):  
Amino Acids ◽  
Ketone Bodies ◽  
Blood Glucose Concentration ◽  
Plasma Concentrations ◽  
Liver Mitochondria ◽  
Branched Chain Amino Acids ◽  
Oxidation Products ◽  
Rat Liver Mitochondria ◽  
Toxic Metabolite ◽  
Branched Chain

We describe the effects of methylenecyclopropylglycine in fasted rats. A 75% decrease in the blood glucose concentration and an increase of lactate and pyruvate were observed 6 h after administration of 100 mg of this amino acid/kg. By contrast with the effects reported for hypoglycin [Williamson & Wilson (1965) Biochem. J. 94, 19c-21c], the plasma concentrations of ketone bodies decreased after administration of methylenecyclopropylglycine and the concentrations of branched-chain amino acids in the plasma were increased 6-fold. The oxidation of decanoylcarnitine or of palmitate was nearly completely inhibited in rat liver mitochondria from methylenecyclopropylglycine-poisoned rats. The activities of acetoacetyl-CoA and of 3-oxoacyl-CoA thiolase were decreased to 25% and less than 10% of the controls. There was a pronounced aciduria, due to the excretion of dicarboxylic acids and of oxidation products of branched-chain amino acids. The accumulation of the toxic metabolite methylenecyclopropylformyl-CoA in the mitochondrial matrix was detected after administration of methylenecyclopropylglycine. Similarly we confirmed experimentally that methylenecyclopropylacetyl-CoA accumulates in mitochondria incubated with methylenecyclopropylpyruvate.

scholarly journals Oocyte quality in lactating dairy cows fed on high levels of n-3 and n-6 fatty acids

Reproduction ◽  
2009 ◽  
Vol 138 (5) ◽  
pp. 771-781 ◽  
Author(s):  
Ali A Fouladi-Nashta ◽  
Karen E Wonnacott ◽  
Carlos G Gutierrez ◽  
Jin G Gong ◽  
Kevin D Sinclair ◽  
...  
Keyword(s):  
Amino Acids ◽  
Fatty Acids ◽  
Dairy Cows ◽  
Embryo Quality ◽  
Plasma Concentrations ◽  
Latin Square ◽  
Oocyte Quality ◽  
Reproductive Hormones ◽  
Developmental Potential ◽  
Lactating Dairy Cows

Different fatty acid (FA) sources are known to influence reproductive hormones in cattle, yet there is little information on how dietary FAs affect oocyte quality. Effects of three dietary sources of FAs (supplying predominantly palmitic and oleic, linoleic (n-6) or linolenic (n-3) acids) on developmental potential of oocytes were studied in lactating dairy cows. A total of 12 Holstein cows received three diets containing rumen inert fat (RIF), soyabean or linseed as the main FA source for three periods of 25 days in a Latin-square design. Within each period, oocytes were collected in four ovum pick-up sessions at 3–4 day intervals. FA profiles in plasma and milk reflected profiles of dietary FA sources, but major FAs in granulosa cells were not affected. Dietary FA source did not affect plasma concentrations of leptin, insulin, IGF1, GH, or amino acids. RIF led to a higher proportion of cleaved embryos than soya or linseed, but blastocyst yield and embryo quality were not affected. It is concluded that the ovary buffers oocytes against the effects of fluctuations in plasma n-3 and n-6 FAs, resulting in only modest effects on their developmental potential.

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