Original communication| Volume 114, ISSUE 5, P951-959, November 1993

Download started.


Time course and variability of the endocrine and metabolic response to severe sepsis

      This paper is only available as a PDF. To read, Please Download here.


      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Frayn KN
        Hormonal control of metabolism in trauma and sepsis.
        Clin Endocrinol. 1986; 24: 577-599
        • Wilmore DW
        Hormonal responses and their effect on metabolism.
        Surg Clin North Am. 1976; 56: 999-1018
        • Frayn KN
        • Price DA
        • Maycock PF
        • Carroll SM
        Plasma somatomedin activity after injury in man and its relationship to other hormonal and metabolic changes.
        Clin Endocrinol. 1984; 20: 179-187
        • Buonpane EA
        • Brown RO
        • Boucher BA
        • Fabian TC
        • Luther RW
        Use of fibronectin and somatomedin-C as nutritional markers in the enteral nutrition support of traumatized patients.
        Crit Care Med. 1989; 17: 126-132
        • Little RA
        Thermoregulation and metabolic rate in injury and sepsis.
        in: J-L Vincent Update in intensive care and emergency medicine. Springer Verlag, Berlin Heidelberg1987: 16-25
        • Siegel JH
        • Cerra FB
        • Coleman B
        • et al.
        Physiological and metabolic correlations in human sepsis.
        Surgery. 1979; 86: 163-193
        • Chiolero R
        • Schutz Y
        • Lemarchand Th
        • et al.
        Hormonal and metabolic changes following severe head injury or noncranial injury.
        JPEN. 1989; 13: 5-12
        • Alberti KGMM
        • Batstone GF
        • Foster K
        • Johnston DG
        Relative role of various hormones in mediating the metabolic response to injury.
        JPEN. 1980; 4: 141-146
        • Goschke H
        • Bar E
        • Girard J
        • et al.
        Glucagon, insulin, cortisol, and growth hormone levels following major surgery: their relationship to glucose and free fatty acid elevations.
        Horm Metab Res. 1978; 10: 465-470
        • Voerman HJ
        • Strack van Schijndel RJM
        • Thijs LG
        Endocrine disturbances in the critically ill: the role of growth hormone and cortisol.
        in: J-L Vincent Update in intensive care and emergency medicine. Springer Verlag, Berlin Heidelberg1990: 809-820
        • Cerra FB
        • Siegel JH
        • Border JR
        • Peters DM
        • McManamy RR
        Correlations between metabolic and cardiopulmonary measurements in patients after trauma, general surgery and sepsis.
        J Trauma. 1979; 19: 621-629
        • Baue AE
        • Gunther B
        • Hartl W
        • Ackenheil M
        • Heberer G
        Altered hormonal activity in severely ill patients after injury or sepsis.
        Arch Surg. 1984; 119: 1125-1132
        • Marchuk JB
        • Finley RJ
        • Groves AC
        • Wolfe LI
        • Holloday RL
        • Duff JH
        Catabolic hormones and substrate patterns in septic patients.
        J Surg Res. 1977; 23: 177-182
        • Knaus WA
        • Draper EA
        • Wagner DP
        • Zimmerman JE
        APACHE II: a severity of disease classification system.
        Crit Care Med. 1985; 13: 818-829
        • Keene AR
        • Cullen DJ
        Therapeutic intervention scoring system: update 1983.
        Crit Care Med. 1983; 11: 1-3
        • Buzby GP
        • Knox LS
        • Crosby LO
        • et al.
        Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients.
        Am J Clin Nutr. 1988; 47: 366-381
        • Lamber K
        Photometric determination of nitrogen. Wet incineration followed by formation of indophenol blue with salicylate/hypochlorite.
        Clin Chim Acta. 1976; 67: 107-110
        • Teerlink T
        • De Boer E
        Determination of 3-methylhistidine in urine by high-performance liquid chromatography using precolumn derivatization with 9-fluorenylmethyl chloroformate.
        J Chromatogr. 1989; 491: 418-423
        • Weissman C
        • Kemper M
        • Elwyn DH
        • Askanazi J
        • Hyman AI
        • Kinney JM
        The energy expenditure of the mechanically ventilated critically ill patient.
        Chest. 1989; 89: 254-259
        • Kishikawa M
        • Hiraide A
        • Sugimoto H
        • Yoshioka T
        • Sugimoto T
        Continuous measurement of indirect calorimetry in severely burned patients [Abstract].
        Clin Nutr. 1990; 10: S57
        • Simonson DC
        • DeFronzo RA
        Indirect calorimetry: methodological and interpretative problems.
        Am J Physiol. 1990; 258: E399-E412
        • Frayn KN
        Calculation of substrate oxidation rates in vivo from gaseous exchange.
        J Appl Physiol. 1983; 55: 628-634
        • Ferrannini E
        The theoretical bases of indirect calorimetry: a review.
        Metabolism. 1988; 37: 287-301
        • Ross R
        • Miell J
        • Freeman E
        • et al.
        Critically ill patients have high basal growth hormone levels with attenuated oscillatory activity associated with low levels of insulin like growth factor-1.
        Clin Endocrinol. 1991; 35: 47-54
        • Dahn MS
        • Lange P
        Hormonal changes and their influence on metabolism and nutrition in the critically ill.
        Intensive Care Med. 1982; 8: 209-213
        • Dahn M
        • Kirkpatrick JR
        • Bouwman D
        Sepsis, glucose intolerance, and protein malnutrition.
        Arch Surg. 1980; 115: 1415-1418
        • Porte D
        A receptor mechanism for the inhibition of insulin release by epinephrine in man.
        J Clin Invest. 1967; 46: 86-94
        • Voerman HJ
        • Strack van Schijndel RJM
        • Groeneveld ABJ
        • De Boer H
        • Nauta JP
        • Thijs LG
        Pulsatile hormone secretion during severe sepsis; accuracy of different blood sampling regimens.
        Metabolism. 1992; 41: 934-940
        • Yelich MR
        • Umporowicz DM
        • Qi M
        • Jones SB
        Insulin-inhibiting effects of epinephrine are blunted during endotoxicosis in the rat.
        Circ Shock. 1991; 35: 129-138
        • Ross RJM
        • Miell JP
        • Holly JMP
        • et al.
        Levels of GH binding activity, IGFBP-1, insulin, blood glucose and cortisol in intensive care patients.
        Clin Endocrinol. 1991; 35: 361-367
        • Scein RMH
        • Sprung CL
        • Marcial E
        • Napolitano L
        • Chernow B
        Plasma cortisol levels in patients with septic shock.
        Crit Care Med. 1990; 18: 259-263
        • Greig PD
        • Elwyn DH
        • Askanazi J
        • Kinney JM
        Parenteral nutrition in septic patients: effect of increasing nitrogen intake.
        Am J Clin Nutr. 1987; 46: 1040-1047
        • Smith R
        • Fuller DJ
        • Wedge JH
        • Williamson DH
        • Alberti KGGM
        Initial effect of injury on ketone bodies and other blood metabolites.
        Lancet. 1975; i: 1-3
        • Kaminski MV
        • Neufeld HA
        • Pace JG
        Effect of inflammatory and noninflammatory stress on plasma ketone bodies and free fatty acids and on glucagon and insulin in peripheral and portal blood.
        Inflammation. 1979; 3: 289-294
        • Beylot M
        • Guiraud M
        • Grau G
        • Bouletrau P
        Regulation of ketone body flux in septic patients.
        Am J Physiol. 1989; 257: E665-E674
        • Neufeld HA
        • Pace JG
        • Kaminski MV
        • et al.
        A probable endocrine basis for the depression of ketone bodies during infectious or inflammatory state in rats.
        Endocrinology. 1980; 107: 596-601
        • Carpentier YA
        • Askanazi J
        • Elwyn DH
        • et al.
        Effects of hypercaloric glucose infusion on lipid metabolism in injury and sepsis.
        J Trauma. 1979; 19: 649-654
        • Van Lanschot JJB
        • Feenstra BWA
        • Looijen R
        • Vermeij CG
        • Bruining HA
        Total parenteral nutrition in critically ill surgical patients: fixed vs tailored caloric replacement.
        Intensive Care Med. 1987; 13: 46-51