Hepatic insufficiency and increased proteolysis, cardiac output, and oxygen consumption following hemorrhage.
Thirty dogs underwent hemorrhage over a 60-min period to a predetermined O2 debt of 60-120 mL O2/kg, monitored with a Beckman metabolic cart, and then were resuscitated with 120% of the shed volume. Twenty survived and were followed over the next 7 days. On day 4, hepatic insufficiency was suggested by an elevation in [total amino acids] and [lactate] and a decrease in [urea] and [branched-chain amino acids]/[aromatic amino acids]. Net whole body catabolism on day 4 is suggested by a decrease in [glutamine] and an increase in plasma [3-methylhistidine], [phenylalanine], and [tyrosine]. These changes were significantly related to cardiac index, mean blood pressure, [lactate], O2 debt, and shed volume during the hemorrhage 4 days earlier. On day 7 there was a significant increase in the cardiac index and the VO2. These data suggest that hemorrhage induces sequelae similar to major injury or sepsis: hepatic insufficiency, net catabolism, hypermetabolism, and a hyperdynamic circulation. The hyperdynamic circulation may be necessary to meet increased tissue delivery requirements for O2 and amino acids.
Dunham
C M
CM
Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore.
Fabian
M
M
Siegel
J H
JH
Gettings
L
L
D000596:Amino Acids / Q000097:blood; D000597:Amino Acids, Branched-Chain / Q000097:blood; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D002302:Cardiac Output; D004285:Dogs; D010450:Endopeptidases / Q000378:metabolism*; D005973:Glutamine / Q000097:blood; D006439:Hemodynamics; D006470:Hemorrhage / Q000503:physiopathology*; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008099:Liver / Q000503:physiopathology*; D008762:Methylhistidines / Q000097:blood; D010101:Oxygen Consumption; D014508:Urea / Q000097:blood
D000596:Amino Acids; D000597:Amino Acids, Branched-Chain; D001786:Blood Glucose; D007773:Lactates; D008762:Methylhistidines; D005973:Glutamine; D019344:Lactic Acid; D014508:Urea; D010450:Endopeptidases; C028118:3-methylhistidine