Endokrin dan metabolic respon

terhadap trauma

Hendy Buana Vijaya

 Endocrine and metabolic response to trauma

• Stress is defined as a state of threatened homeostasis resulting

from exposure to adverse forces (stressors) such as trauma,
infections, burns and surgery.
Response to trauma includes various endocrine, metabolic and
immunological changes. The severity of these changes is related to the
amount of exposed stress.
Endocrine organs
Hypothalamus
Pituitary
Adrenal
Major mediator
 Metabolic response
Ebb Phase : Occurs within minutes after trauma
• Hypovolemic shock, hypoxia, decrease of energy expenditure
Flow Phase : Occurs hours after trauma
• Tissue perfusion is restored, volume deficit is controlled, hypermetabolic
status, hyperglycemia, hyperthermia.
• Has two sub phase : catabolic and anabolic sub phase
• Catabolism is degradative metabolism involving the release of energy and
resulting in the breakdown of complex materials (such as proteins or lipids)
within the organism.
• Anabolim is the constructive part of metabolism concerned especially with
macromolecular synthesis
Ebb phase and Flow phase
Ebb phase and Flow phase
 Strategy to attenuate metabolic response
• Ebb phase Flow phase
• Prompt fluid and blood • Nutritional support
replacement to maintain blood • Warm room temperature
preasure
• Adequate oxygen suplay and • Mobilization
ventilation • Hemodialysis
• Cardiovascular support • Timely intervention for
• Antibiotics complication
 Macronutrient
Carbohydrate
• At least 100g/day neededfor prevent ketosis
• Carbohydrate intake during stress should be between 30%-40% of total
calories
• Glucose intake should not exceed 5 mg/kg/min
• Maximum recommendation for intravenous lipid infusion: 1.0 -1.5 g/kg/day
Protein
• Requirements range from 1.2-2.0 g/kg/day during stress
• Comprise 20%-30% of total calories during