[Pathophysiology of post-aggression metabolism]

The metabolic situation of the socalled "post aggression syndrome" related to operations or trauma is elucidated in terms of two out of three phases described by a working hypothesis. It is governed primarily by anti insulin factors and can be identified by the resulting catabolism. The leading phenomena are increased of general turnover rates, glycogenolysis, gluconeogenesis, lipolysis, and protein degradation. An "ergotropic situation" results, obviously being an important basis of survival. On the other hand, changes in the protein metabolism do not exclusively concern proteolysis, but also a flow of substrates from the periphery to visceral organs and wound healing tissue. In these tissues important synthetic processes are still prevailing, despite the general catabolic state. These efforts of the organism to survive ought to be supported synergistically rather than antagonised by therapeutic means. Therefore it seems important that care is taken primarily to select an appropriate nutritional regime for parenteral or if feasible enteral administration before taking into account pharmacological measures with regard to the metabolic disturbances.