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Background. Experimental reports have indicated that hepatic oxidative and synthetic metabolism
may become depressed in sepsis. Because the mechanism of infection-related liver dysfunction
has not been established, further study of these functional alterations could contribute
to the therapeutic management of septic organ failure syndromes. However, recently
controversy has arisen over the existence of these derangements that must be reconciled
before further progress in this field can be made.
Methods. Splanchnic balance studies for the measurement of glucose output and oxygen consumption
were used to assess hepatic function in fasted normal volunteers (n=18), injured patients
(n=10), and patients with sepsis (n=18). The liver's contribution to splanchnic metabolism
was estimated from a comparison of splanchnic oxygen utilization in response to increases
in the liver-specific process of glucogenesis. In addition, in vivo liver albumin
production was determined by using the [14C] carbonate technique.
Results. Glucose output after injury and sepsis was increased by 12.8% and 76.6%, respectively,
compared with controls. On the basis of substrate balance studies, gluconeogenesis
was estimated to account for 46%, 87%, and 93%, respectively, of splanchnic glucose
output in each of the three groups. In patients with sepsis glucose output was also
noted to be linearly related to regional oxygen consumption, indicating that these
processes were coupled and increases in the respiratory activity of the splanchnic
cellular mass could be accounted for by increases in new glucose output and gluconeogenic
substrate clearance. The mean albumin synthetic rate increased during injury and sepsis
by 22% and 29%, respectively, compared with normal volunteers.
Conclusions. These studies cast doubt on the commonly held notion that tissue respiratory dysfunction
may occur during sepsis. On the contrary, hepatic function is accelerated during hyperdynamic
sepsis, and evidence indicating oxidative or synthetic functional depression is lacking.
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Article info
Publication history
Accepted:
September 21,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
