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inflammation

cardiac and circulatory performance, which increases blood flow to the wound. Liver and kidney blood flow also increase, with increased delivery of gluconeogenic precursors, increased glucose release into the circulation, and increased nitrogen clearance. The release of fat from adipose tissue is stimulated by catecholamines. In the liver, fat metabolism to glycerol and free fatty acids produces energy as long as an adequate glucose supply replenishes oxaloacetic acid for oxidation of acetyl CoA, the product of triacylglycerol oxidation.

I I Severe burn injury I I Severe bony injury

I I Severe burn injury I I Severe bony injury

Week 24

Week 10

a Week 5 e

Tim Week 4

Week 3 Week 2 Week 1

50 100% 150 200% Resting metabolism as % of normal value

Figure 2 The stress response to thermal injury is greater than that to any other insult. The resting energy requirements in burns patients are greater for longer than for any other injury. (Adapted with permission from Long CL, Schaffel N, Geiger JW et al. (1979) Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance. Journal of Parenteral and Enteral Nutrition 3(6): 452-456.)

Week 24

Week 10

a Week 5 e

Tim Week 4

Week 3 Week 2 Week 1

50 100% 150 200% Resting metabolism as % of normal value

Figure 2 The stress response to thermal injury is greater than that to any other insult. The resting energy requirements in burns patients are greater for longer than for any other injury. (Adapted with permission from Long CL, Schaffel N, Geiger JW et al. (1979) Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance. Journal of Parenteral and Enteral Nutrition 3(6): 452-456.)

Thus, both continued oxygen and glucose must be supplied to prevent ketoacidosis. Heat production and energy wastage occur as a result of a 2- or 3fold increase in futile cycling of substrates; glucose, pyruvate, and fructose-6-phosphate are all involved in these reactions.

Gluconeogenesis can occur only in the liver and is increased by catecholamines and glucagon. The plasma levels of gluconeogenic amino acids (alanine and glutamine) initially increase during the first 2 days, when glycogen is preferentially metabolized, but subsequently decrease. Days 4-7 are associated with a maximal decrease in plasma levels of gluco-neogenic amino acids, whereas muscle production and hepatic consumption are both increased.

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