Abnormalities of Energy Metabolism in Sepsis and Endotoxemia

  • G. H. A. ClowesJr.
  • T. F. O’DonnellJr.
  • N. T. Ryan


Patients who survive severe infections characteristically have low peripheral vascular resistances and maintain elevated cardiac indices in excess of 4 L/M2/min to satisfy the high circulatory demand (1, 2, 3). On the other hand, the mortality of patients who are more than transiently hypotensive with cardiac outputs below the normal resting value is greater than 60% (4, 5). Certain well-known metabolic abnormalities accompany the septic state. Proteolysis and negative nitrogen balance far exceed the values observed in simple starvation (6, 7, 8). Blackburn et al. (9, 10) have demonstrated that in many such patients under these conditions the utilization of endogenous fat is suppressed by elevation of blood insulin secondary to glucose infusion. A pseudo diabetes and insulin resistance are typical of the seriously infected patient (11). Lactacidemia is known to accompany the low flow state, and often is found in the presence of high outputs (5). McLean et al. (12) suggest that the prognosis of the seriously infected patient is closely related to the blood lactate value.


Hind Limb Septic Patient Cecal Ligation Blood Insulin Flow Group 
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  1. 1.
    Clowes, G. H. A., Jr., Farrington, G. H., Zuschneid, W., Cossette, G. R., Saravis, C.A.: Ann. Surg. 171: 663 (1970).PubMedCrossRefGoogle Scholar
  2. 2.
    Shoemaker, W. C.: Surg. Gynec. Obstet. 134: 810 (1972).PubMedGoogle Scholar
  3. 3.
    Siegal, J., Greenspan, M., DelGuercio, L. R. M.: Ann. Surg. 165: 504 (1967).CrossRefGoogle Scholar
  4. 4.
    Clowes, G. H. A., Jr., Vucinic, M., Weidner, M. G.: Ann. Surg. 163: 6 (1966).CrossRefGoogle Scholar
  5. 5.
    Rubin, J. W., Clowes, G.H. A.: Surg. Clin. N. Amer. 49: 489 (1969).PubMedGoogle Scholar
  6. 6.
    Cahill, G. F., Jr.: Diabetes 20: 785 (1971).PubMedGoogle Scholar
  7. 7.
    Cuthbertson, D.P., Tilstone, W. J.: Adv. clin. Chem. 12: 1 (1969).PubMedCrossRefGoogle Scholar
  8. 8.
    Long, C.L., Spencer, J. L., Kinney, J. M., Geiger, J. W.: J. appl. Physiol. 31: 110 (1971).PubMedGoogle Scholar
  9. 9.
    Blackburn, G. L., Flatt, J.P., Clowes, G. H. A., Jr., O’ Donnell, T. F., Jr.: Amer. J. Surg. 125: 447 (1973).PubMedCrossRefGoogle Scholar
  10. 10.
    Blackburn, G. L., Flatt, J.P., Clowes, G. H. A., Jr., O Donnell, T.F., Jr., Hensle, T. E.: Ann. Surg. 177: 588 (1973).PubMedCrossRefGoogle Scholar
  11. 11.
    Howard, J.M.: Ann. Surg. 141: 321 (1955).PubMedCrossRefGoogle Scholar
  12. 12.
    MacLean, L., Mulligan, W., McLean, A., Duff, J.: Ann. Surg. 166: 543 (1967).PubMedCrossRefGoogle Scholar
  13. 13.
    Bergmeyer, H. U., Bernt, E.: In: Bergmeyer, H.U.: Methods of Enzymatic Analysis, p. 313 ( Academic Press, New York/London 1963 ).Google Scholar
  14. 14.
    Dole, V.P., Meinertz, H.: J. Biol. Chem. 235: 2595 (1960).PubMedGoogle Scholar
  15. 15.
    Soeldner, J.S., Slone, D.: Diabetes 14: 771 (1965).PubMedGoogle Scholar
  16. 16.
    Porte, D., Jr., Graber, A. L., Kuzuya, T., Williams, R. H.: J. clin. Invest. 45: 228 (1966).PubMedCrossRefGoogle Scholar
  17. 17.
    Cryer, P. E., Herman, C.M, Sode, J.: Ann. Surg. 174: 91 (1971).PubMedCrossRefGoogle Scholar
  18. 18.
    Rutenburg, S., Skarnes, R., Palmerio, C., Fine, J.: Proc. Soc. exp. Biol. Med. 125: 455 (1967).Google Scholar
  19. 19.
    Berry, L. J., Rippe, D. F.: J. infect. Dis., Suppl. 128: 118 (1973).CrossRefGoogle Scholar
  20. 20.
    Issekutz, B., Jr., Miller, H.I., Paul, P., et al.: Amer. J. Physiol. 209: 1137 (1965).PubMedGoogle Scholar
  21. 21.
    Kovach, A. G. B., Rosell, S., Sandor, P.: Circulat. Res. 26: 733 (1970).PubMedGoogle Scholar
  22. 22.
    Fredholm, B.: Acta physiol. scand. 81: 110 (1971).PubMedCrossRefGoogle Scholar
  23. 23.
    Zwadyk, R., Jr., Snyder, I.S.: Proc. Soc. exp. Biol. Med. 143: 864 (1973).Google Scholar
  24. 24.
    Drucker, W. R., Craig, J., Kingsbury, B., Hofmann, W., Woodward, H.: Arch. Surg. 85: 557 (1962).CrossRefGoogle Scholar
  25. 25.
    Schumer, W.: Surgery 64: 55 (1968).PubMedGoogle Scholar
  26. 26.
    Ryan, N. T., Blackburn, G. L., Clowes, G. H A., Jr.: Differential tissue sensitivity to elevated endogenous insulin levels during experimental peritonitis in rats.Google Scholar
  27. 27.
    Wieland, O.H., Patzelt, C., Loffler, G.: Europ. J. Biochem. 26: 426 (1972).PubMedCrossRefGoogle Scholar
  28. 28.
    Clowes, G. H. A., Jr. , O’ Donnell, T.F. , Jr. , Ryan, N. T. , Blackburn, G. L.: Energy metabolism in sepsis: treatment based on different patterns in shock and high output state.Google Scholar

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© Springer-Verlag/Wien 1975

Authors and Affiliations

  • G. H. A. ClowesJr.
  • T. F. O’DonnellJr.
  • N. T. Ryan

There are no affiliations available

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