Ciba Foundation Symposium - Energy Metabolism in Trauma

209 Pages·1970·10.156 MB·English

ENERGY METABOLISM
TRAUMA
IN
EN E RGY M ETABOLIS M
IN TRAUMA
A Ciba Foundation Symposium
Edited by
RUTH PORTER
and
JULIE KNIGHT
J. & A. CHURCHILL
104 GLOUCESTER PLACE, LONDON
I 970
First published 1970
Containing 60 illustrations
I.S.B.N. 0.7000.1487.X
@ Longman Group Ltd. 1970
A// rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical, photo-
copying, recording or otherwise, without the prior permission of the copyright owner.
Printed in Great Britain
Contents
B. Stoner The acute effects of trauma on heat production I
H.
Discussion Caldwell, Carlson, Cuthbertson, Heath, Kinney,
Kovdch, Krebs, Munro, Nahas, NCmeth, Stoner, D. H.
Williamson 7
F. T. Caldwell Changes in energy metabolism during recovery
from injury 23
Discussion Coldwell, Clark, Cuthbertson, Johnston, Kinney, Munro,
Nahas, Nheth, Stoner, Jilstone 34
General discussion 2,3-Diphosphoglycerate in trauma
Clark, Kinney, Koj, Kovdch, Nahas, Stoner, D. H.
Williamson, I.R . Williamson 39
W. J. Tilstone The protein component ofthe disturbance of energy
D. P. Cuthbertson metabolism in trauma 43
Discussion Cuthbertson, johnston, Koj, Munro, Nahas, Nkmeth,
Stoner, Jilstone, D. H. Williamson, J. R. Williamson 54
1. W. L. Davies Protein catabolism and energy utilization in burned
Liljedahl patients treated at different environmental temper-
S.-0.
atures 59
Discussion Andersen, Caldwell, Clark, Cuthbertson, Davies,
Johnston, Kinney, Koj, Munro, Nahas, Nheth, Stoner,
Jilstone, Wilkinson 71
A. Koj Synthesis and turnover of acute-phase reactants 79
Discussion Andersen, Cuthbertson, johnston, Koj, Munro, Nohas,
Stoner, Jilstone 88
General discussion Protein metabolism after injury
Coldwell, Clark, Cuthbertson, johnston, Kinney, Koj,
Munro, Stoner, Jilstone, Wilkinson, J. R. Williamson 93
J. M. Kinney Carbohydrate and nitrogen metabolism after injury I03
C. L. Long
J. H. Duke
Discussion Carlson, Clark, Heath, Kinney, Koj, Krebs, Nheth,
Stoner, D. H. Williamson I23
C. J. Threlfall Intermediary carbohydrate metabolism in injured
rat liver in relation to heat production I27
Discussion Heath, Koj, Kovdch, Krebs, Munro, NCmeth, Stoner,
Threlfall, D. H. Williamson, j. R. Williomson I38
J. R. Williamson Effects of E. coli lipopolysaccharide treatment of
B
C. Refino rats on gluconeogenesis I45
K. LaNoue
Discussion Heath, Krebs, Nahas, Stoner, D. H. Williamson, j. R.
Williamson 151
L. A. Carlson Mobilization and utilization of lipids after trauma:
relation to caloric homeostasis I55
Discussion Caldwell, Carlson, johnston, Kinney, Koj, Kovdch,
Krebs, Munro, Nahas, Walters, D. H. Williamson I63
V
vi CONTENTS
R. N. Barton Ketone body metabolism after trauma 173
Discussion Barton, Krebs, D. H. Williamson, I. R. Williamson 181
General discussion Cothbertson, Heath, Krebs. Munro, Nahas, NCmeth,
Stoner, Threlfall, Wilkinson, D. H. Williamson I83
Author Index
I95
Subject Index I96
P4 em be rs h ip
Symposium Energy Metabolism in Trauma, held
on
I7th-18th February 1970
Sir Hans Krebs Metabolic Research Laboratory, Nuffield Department of
(Chairman) Clinical Medicine, Radcliffe Infirmary, Oxford, England
B. Andersen Institute of Medical Physiology, University of Copen-
S.
hagen, Juliane Mariesvej 28, 2100 Copenhagen, Denmark
R. N. Barton Experimental Pathology of Trauma Section, MRC Toxi-
cology Unit, Woodmansterne Road, Carshalton, Surrey,
England
F. T. Caldwell, Jr Department of Surgery, University of Arkansas, Medical
Center, 4301 West Markham, Little Rock, Arkansas,
U.S.A.
L. A. Carlson King Gustaf Vth Research Institute, Stockholm 60,
Sweden and Department of Geriatrics, University of
Uppsala, Sweden
R. G. Clark University Department of Surgery, The Royal Infirmary,
Sheffield 6, England
Sir David Cuthbertson Department of Pathological Biochemistry, The Royal
Infirmary, Glasgow C.4, Scotland
1. W. Davies MRC Injuries and Burns Research Unit, Birmingham
L.
Accident Hospital, Birmingham 15, England
D. F. Heath Experimental Pathology of Trauma Section, MRC Toxi-
cology Unit, Woodmansterne Road, Carshalton, Surrey,
England
1. D. A. Johnston Department of Surgery, Royal Victoria Infirmary,
Newcastle-upon-Tyne NEI 4LP, England
J. M. Kinney Department of Surgery, College of Physicians and
Surgeons, Columbia University, 630 West 168th Street,
New York, N.Y. 10032, U.S.A.
A. Koj Department of Biochemistry and Biophysics, Jagiellonian
University, Grodzka Krak6w. Poland
53,
A. G. B. Kovach Experimental Research Department, Medical University
of Budapest, Ulloi lit 78/a, Budapest VIII, Hungary
H. N. Munro Deoartment of Nutrition and Food Science. Massachusetts
lnsiitute of Technology, Cambridge, Massachusetts 0213 9,
U.S.A.
G. G. Nahas Department of Anesthesiology, College of Physicians and
Surgeons, Columbia University, 630 West 168th Street,
New York, N.Y. 10032, U.S.A.
Nbmeth Institute of Endocrinology, Slovak Academy of Sciences,
S.
Obrancov mieru I/a, Bratislava, Czechoslovakia
vii
viii MEMBERSHIP
H. B. Stoner Experimental Pathology of Trauma Section, MRC Toxi-
cology Unit, Woodmansterne Road, Carshalton, Surrey,
England
C. J. Threlfall Experimental Pathology of Trauma Section, MRC Toxi-
cology Unit, Woodmansterne Road, Carshalton, Surrey,
England
W. 1. Tilstone Department of Pathological Biochemistry, The Royal
Infirmary, Glasgow C.4, Scotland
G. Walters Chemical Pathology Laboratory, New Cross Hospital,
Wolverhampton, England
A. W. Wilkinson Institute of Child Health, University of London, 30
Guilford Street, London W.C. I, England
D. H. Williamson Metabolic Research Laboratory, Nuffield Department of
Clinical Medicine, Radcliffe Infirmary, Oxford, England
J. R. Williamson Department of Biophysics and Physical Biochemistry,
Johnson Research Foundation, The School of Medicine,
University of Pennsylvania, Philadelphia 19104, U.S.A.
Dr H. B. Stoner first wrote to the Director of the Ciba Foundation about
this symposium in 1968. He suggested that research on the biochemical
aspects of energy metabolism in trauma was reaching a stage at which it
could be usefully discussed by a small multidisciplinary group of research
workers and clinicians. As the subject of thc Royal College of Pathologists’
annual symposium for 1970-to take place in February-was the Pathology
of Trauma, Dr Stoner suggested that the smaller meeting might also be
held in February so that some of the participants, especially those
1970,
from abroad, could come to both meetings. The Foundation has enjoyed
this opportunity of Cooperating with the Royal College over these two
symposia.
We wish to put on record here our gratitude to Dr Stoner for his various
suggestions. We would also like to thank him for his constant advice and
concern in planning our meeting, for the role that he himself, and the mem-
bers of his department, played in it and, finally, for his help in editing the
proceedings which form this volume. We would particularly like to thank
the Chairman, Sir Hans Krebs, for his support and guidance at various
stages and for the skill with which hc took the Chair at the meeting.
I* ir
The Ciba Foundation
The Ciba Foundation was opened in to promote
1949
international cooperation in medical and chemical re-
search. It owes its existence to the generosity of CIBA
Ltd., Basle, who, recognizing the obstacles to scientific
communication created by war, man’s natural secretiveness, dis-
ciplinary divisions, academic prejudices, distance, and differences
of language, decided to set up a philanthropic institution whose
aim would be to overcome such barriers. London was chosen as
its site for reasons dictated by the special advantages of English
charitable trust law (ensuring the independence of its actions), as
well as those of language and geography.
The Foundation’s house at Portland Place, London, has
41
become well known to workers in many fields of science. Every
year the Foundation organizes six to ten three-day symposia and
three or four shorter study groups, all of which are published in
book form. Many other scientific meetings are held, organized
either by the Foundation or by other groups in need of a meeting
place. Accommodation is also provided for scientists visiting
London, whether or not they are attending a meeting in the house.
The Foundation’s many activities are controlled by a small
group of distinguished trustees. Within the general framework
of biological science, interpreted in its broadest sense, these activi-
ties are well summed up by the motto of thc CiLa Foundation:
Consocient Gentes-let the peoples come together.
ENERGY METABOLISM IN TRAUMA
RUTH PORTER &JULIE KNIGHT
Cowriqht 0 1970 Ciba Foundation
THE ACUTE EFFECTS OF TRAUMA ON HEAT
PRODUCTION
H. B. STONER
Experimental Pathology of Trauma Section, M.R.C. Toxicology Unit, M.R.C. Laboratories,
Carshalton, Surrey
AT ordinary room temperatures (20°C) trauma leads to a series of
changes in the rate of heat production as shown by direct gradient layer
calorimetry (Cairnie et a!., 1957; Stoner and Pullar, 1963; Miksche and
Caldwell, 1968; Caldwell, Hammel and Dolan, 1966). Shortly after the
injury a steady state of diminished heat production is established which is
termed the “ebb” phase. This may be followed either by recovery and
transition to a phase of increased heat production-the “flow” phase-or
by further progressive depression of heat production until death. Our
group has been concerned with the changes of the “ebb” phase after limb
ischaemia or burns in albino rats of the Porton strain fed on M.R.C. diet
B. Bilateral hind-limb ischaemia has been produced with tourniquets
41
(Rosenthal, 1943). Ischaemia for two hours is not lethal, but 4 hours of
ischaemia causes the death of 70-8a per cent of the rats. Those which die
do so between 5 and 24 hours after removal of the tourniquets, the average
survival time being abour 12 hours. Non-fatal full-thickness scalds were
produced by immersing the dorsum in water at 83°C for 30 seconds so as
to scald 20 per cent of the skin surface (Arturson, 1961). The rats were
anaesthetized for only about 3 minutes during the application of the tourni-
quets or the immersion.
In animals with small thermal capacity like the rat the fall in heat pro-
duction is followed by a fall in core temperature. After a fatal injury the
final core temperature may be only a few degrees above the ambient but in
non-fatal cases it does not usually fall below about 32°C. The duration of
the “ebb” stage is variable and is inversely related to the severity of the
injury in the sense that after a very severe injury, features of the terminal
phase soon appear at the expense of the “ebb” phase. After 4 hours bi-
lateral hind-limb ischaemia in the fed rat in a 20°C environment the “ebb”
phase may be as short as 3-4 hours, whereas after non-fatal injuries it may
last 24 hours.
I