title: Glucose turnover, oxidation, and indices of recycling in severely traumatized patients.
abstract: Hyperglycemia is often seen in trauma patients and its etiology is not clearly understood. We have determined parameters of glucose metabolism by using simultaneous primed-constant intravenous infusion of both [6-3H] glucose and [U-14C] glucose in ten severely traumatized hypermetabolic subjects during the early "flow phase" of injury and in six post-absorptive normal volunteers. The mean rate of glucose production (determined by means of [6-3H] glucose) was 3.96 +/- 0.40 mg/kg/min in trauma patients, which was significantly (p = 0.025) higher than the value of 2.75 +/- 0.13 observed in normal volunteers. Glucose turnover rates determined with [U-14C] glucose as tracer were lower in all subjects. The difference between the turnover rates determined by the two tracers represents an index of recycling of glucose through three-carbon fragments. This recycling index was similar in both groups of subjects in amount (0.24 +/- 0.07 vs. 0.26 +/- 0.08 mg glucose/kg/min) but different when expressed as percentage of total glucose turnover (5.6 +/- 1.4% vs. 9.8 +/- 1.7%; p = 0.05). The absolute rates of glucose clearance, oxidation, and recycling were similar in stressed trauma patients and unstressed controls although the rate of production was increased by 44% due to injury. Post-trauma hyperglycemia was mainly due to an increased hepatic output of glucose and not due to a decreased ability of the tissue to extract glucose from the plasma. Hyperglycemia may be the driving force in the metabolic effects of injury.
authors.affiliation: Trauma Center, St. Joseph's Hospital & Medical Center, Phoenix, Arizona 85013.
authors.forename: M
authors.initials: M
authors.lastname: Jeevanandam
authors.forename: D H
authors.initials: DH
authors.lastname: Young
authors.forename: W R
authors.initials: WR
authors.lastname: Schiller
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002250:Carbon Radioisotopes; D002648:Child; D002675:Child, Preschool; D005260:Female; D005947:Glucose / Q000378:metabolism* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000209:etiology; D007260:Infusion Pumps; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000378:metabolism*; D010084:Oxidation-Reduction; D011506:Proteins / Q000378:metabolism; D014316:Tritium
chemical_list: D001786:Blood Glucose; D002250:Carbon Radioisotopes; D011506:Proteins; D014316:Tritium; D005947:Glucose