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Section VI:
STRESS RESPONSE TO BURN INJURY
The effects of a burn or trauma differ from those
of simple starvation due to activation of the “stress response”, a neural and
endocrine response, which accelerates the loss of lean tissue and inhibits
adaptation. A significant alteration in normal metabolic activity occurs. Any
insult will activate the response.
The host response to injury (afferent arc) is an
amplification of the “fright-flight response”. A bodily insult, especially a
burn, activates a very abnormal hormonal response, in large part due to
neuro-activation of the pituitary adrenal axis, led by a marked increase in
catecholamines and cortisol (efferent arc). These changes produce a profound
hypermetabolic-catabolic state. Human growth hormone and testosterone levels
decrease, leading to a decrease in anabolic drive and a further increase in
catabolism. The degree of hypermetabolism and catabolism from any insult is
dependent on the degree of injury.
| Figure 7:
Stress Response
to Injury |
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| The original
intent of this response was to make readily available glucose for
energy to tolerate an insult. The initial adaptive response, which
obtains glucose skeletons from protein, was not meant to last more
than a few hours or days. The response becomes maladaptive when
lasting days to weeks in the burn patient. |
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CAUSE OF STRESS RESPONSE |
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| Figure 8:
An elective surgical procedure |
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| Figure 9:
Blunt abdominal trauma |
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| Figure 10:
A simple humerus fracture |
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| Figure 11:
A wound
infection |
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| Figure 12:
Burn: The ultimate
stress |
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[Metabolic
Response]   [Controlling
Stress
Response]
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