Derangements in peripheral glucose and oxygen utilization induced by catabolic hormones

Objective: To assess if the derangements in peripheral glucose, lactate, and oxygen utilization that are observed in severely injured patients are due to the hormonal response to injury or are related to the extent of the wound. Design: Comparison study. Interventions: The catabolic hormones epinephrine, cortisol, and glucagon were infused simultaneously into the femoral artery of six healthy volunteers, thus simulating the hormonal milieu associated with severe trauma in an uninjured leg. Setting: Clinical research center at a university-affiliated hospital. Patients: Young, adult males deemed healthy by screening medical history, physical examination, and blood chemistries. Measurements and Main Results: Substrate net balance and indirect calorimetry measurements were performed before and then at the completion of 2 hrs of catabolic hormone infusion. Catabolic hormones elicited significant increases in leg glucose uptake and oxidation, and an increased net efflux from the leg of lactate and alanine. While leg oxygen delivery also increased, catabolic hormones failed to alter peripheral oxygen consumption. Conclusions: Catabolic hormones can elicit a similar peripheral metabolic response in an uninjured leg as that reported previously by Wilmore et al. in severely burned extremities. This finding suggests that the hormonal milieu associated with severe injury is influential in regulating peripheral glucose and oxygen utilization and that wound inflammation is not an essential component of this response.