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Abstract
Background. In trauma patients a specific pattern of the hormonoendocrine response to injury
has been described. Conflicting data exist regarding the hormonal changes during sepsis.
We studied the time course and variability of the hormonal and metabolic responses
to severe sepsis in twelve medical patients.
Methods. Hormone levels were measured every 6 hours. Urinary nitrogen and 3-methylhistidine
excretion were measured daily. Indirect calorimetry was used to calculate energy production
rate (EPR).
Results. None of the hormones measured showed a time course m individual patients. Growth.
hormone (1.69 ± 0.17 ng/ml) and insulin (48 ± 5 mU/L) values were within normal range.
Cortisol value (474 ± 44 nmol/L) was in the upper normal range. Insulin-like growth
factor 1 level (12.5 ± 5.7 nmol/L) was decreased. Nitrogen balance was negative and
did not change during the study period. Neither oxygen consumption (Vo2) (318 ± 20 ml/min), carbon dioxide output (283 ± 10 ml/min), EPR (2064 ± 435 kcal/day),
nor fuel utilization showed a time course. The variability during the study period
compared with values on admission ranged from 20% (insulin-like growth factor 1) to
74% (growth hormone). The variability of calculated fuel utilization ranged from 35%
(protein) to 180% (fat). The variability of Vo2, carbon dioxide production, and EPR was far less, 8%.
Conclusions. A specific pattern in the endocrine and metabolic responses as observed in trauma
patients does not occur in medical patients with severe sepsis. Hormones and calculated
fuel utilization show large variations when compared with values on admission. Vo2 and EPR vary far less. Nutritional needs in patients with sepsis, therefore, can
be calculated on admission and need not be recalculated during the first week after
admission.
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Article info
Publication history
Accepted:
September 14,
1992
Footnotes
☆Supported by a grant from Novo-Nordisk Gentofte, Denmark.
Identification
Copyright
© 1993 Published by Elsevier Inc.
