[Cellular metabolic consideration in the pathophysiology and the treatment of shock]

Shock is defined as the summation of cellular dysfunction and resultant impairment of the function in various organs. The typical such condition can be observed in shock-induced multiple organ failure (MOF). Therefore, the most effective and fundamental management against shock should be the improvement of such cellular dysfunction. The present study was undertaken to investigate the cellular metabolic abnormalities and their treatment in shock-induced MOF patients. The severity of cellular damage was evaluated with cellular injury score (CIS), which can be calculated by scoring the values of osmolality gap, arterial ketone body ratio and blood lactate. The CIS correlated significantly with the outcome and the number of failing organs in the MOF patients. Since tissue hypoxia and humoral mediator have been considered to play a key role in the development of such cellular dysfunction, protease inhibitor was administered to such patients and oxygen metabolism was improved with catecholamine. The CIS improved among survived MOF patients following those treatments. These results suggest that the shock-induced MOF is the summation of the cellular dysfunction which can be assessed with the CIS, and that such cellular dysfunction could be improved through the therapeutic approach to the humoral mediators and/or tissue oxygen metabolism.