[Post-traumatic metabolism--bases and clinical aspects]

In order to rationalize the nutritional therapy of polytraumatized patients we have developed a concept to explain the humoral response and subsequent metabolic reactions to trauma, which is based on current reports in the literature and our own investigations. Three separate phases should be defined. a) The acute phase: catecholamines dominate in the initial phase following severe trauma. Insulin secretion is suppressed, and the levels of the anti-insulin hormones glucagon, cortisol and growth hormone are increased. Under modern conditions of treatment this phase lasts between 12-24 h. Nutritional therapy cannot be carried out during this phase of maximal glycogenolysis, lipolysis and gluconeogenesis because of the danger that a major metabolic imbalance might develop. b) The intermediate phase: This phase can be said to occur when after 12-24 h the primary stabilisation of the acute phase is complete. Insulin secretion can now be stimulated, but the levels of anti-insulin hormones remain high. This phase lasts for a number of days. The gradual introduction of nutritional therapy is now possible, but the danger of metabolic imbalances arising when abrupt substrate increases are made is nevertheless present. Should complications arise this phase can at any time revert to the acute phase. Patients who are only slightly injured or have undergone moderately extensive surgery are from the onset in this phase. c) The repair phase: In uncomplicated cases the intermediate phase passes after a number of days into the repair phase. This stage lasts for a number of weeks and is dominated by the presence of insulin. The levels of the anti-insulin hormones have returned to normal values.(ABSTRACT TRUNCATED AT 250 WORDS)