Abnormalities of Energy Metabolism in Sepsis and Endotoxemia

Abstract

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.