Manipulating the metabolic response to injury

In this short review we will concentrate on just one of the features of the metabolic response to injury (classified as accidental trauma, injury or sepsis) which are collectively known as the ‘flow’ phase1. These include an increase in energy expenditure (hypermetabolism), changes in substrate utilisation (insulin resistance) and the focus of this chapter muscle wasting or catabolism. It is recognised that the three features are interrelated, for example insulin is believed to be an important factor in controlling amino acid flux in skeletal muscle2 and increasing environmental temperature which may reduce flow phase hypermetabolism3 has been shown to reduce postoperative nitrogen excretion (a marker of protein catabolism)4. However, we will concentrate on muscle wasting and refer the reader to other reviews on insulin resistance5 and metabolic rate6.