J.Jpn. Surg. Soc.. 58(9): 1388-1405, 1957
SUGAR METABOLISM IN ILEUS SHOCK
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Department of Surgery, Nippon Medical School (Professor Saburo MATSUKURA) Saburo WATANABE |
I . (1) Blood sugar is markedly increased during the course of ileus in vascular areas of the femoral vessels, portal and hepatic veins, but it tends to be decreased during ileus shock. This tendency to decrease for blood sugar in shock is most remarkable in blood of the hepatic vein.
(2) Blood lactic acid value gradually increases in the vascular areas of the femoral vessels, portal and hepatic veins, the increase becoming suddenly and rapidly remarkable during shock. The rate of this increase is particularly high in blood of the hepatic vein.
(3) Pyruvic acid shows a pronounced increase from the early stage of ileus in the vascular areas of the femoral vessels, portal and hepatic veins, but in shock it is decreased. The greatest increase is noted in blood of the hepatic vein.
(4) It is significant to note that whereas blood lactic acid gradually increases with the progress of ileus, the increase becoming rapidly remarkable upon the development of shock, blood pyruvic acid, which is markedly increased from the very beginning, shows a tendency to decrease. Thus, the blood lactic acid-pyruvic acid ratio suddenly assumes a high value when shock develops, and this is an important index of ileus shock.
(5) During ileus shock, tissue glycogen of the liver and muscle is remarkably reduced, and the decrease is particularly marked in the hepatic tissue.
(6) Lactic acid of the hepatic tissue is greatly increased in ileus shock, but pyruvic acid is diminished.
II. The hepatic circulation, like the systemic circulation, suffers a profound disturbance in ileus shock, resulting in a marked reduction in hepatic. blood flow and a depression of blood pressure in the hepatic venules. These changes, in turn, give rise to a pronounced anoxia in the liver with a consequent reduction in the out-pouring of blood sugar.
III. The blood sugar regulating function of the liver is greatly lowered during ileus shock.
This fact is considered to signify a decreased ability of the liver in glycogen synthesis and a disturbance in the intermediate metabolism of carbohydrates, especially when compared with the results of investigation on the changes in the intermediate metabolism, particularly lactic and pyruvic acids, in the blood and liver as well as on the fluctuations of tissue glycogen in the liver and muscle.
IV. (1) Total urinary 17-hydroxycorticoids tend to decrease with the progress of ileus, but they increase slightly on the second day and attain the highest value on the third day of ileus. Thereafter, they begin to decrease gradually and show a remarkable reduction during ileus shock.
(2) The marked changes in the blood sugar concentration during ileus are hardly influenced by the administration of DOCA but they are effectively controlled, though temporarily, by administration of cortisone.
(3) The hyperglycemia developing in the course of ileus can be completely checked by the injection of insulin. When the insulin sensitivity index is determined under such conditions, a definite acceleration can be demonstrated during shock. This fact is interpreted to signify a marked disturbance in the secretion of glucocorticoid from the adrenal cortex during ileus shock.
To epitomize the above findings, during ileus shock a marked anoxic state is proved in the liver as a result of serious disturbances in the hepatic circulation just as in the systemic circulation. The depression of ability to synthesize glycogen, the lowered function of intermediate metabolism of sugar and the decreased power to regulate blood sugars, in combination with a marked reduction in the secretion of glucocorticoids by the adrenal cortex, a profound disturbance in sugar metabolism intervenes during the period of ileus shock, particularly in the intermediate metabolism of lactic and pyruvic acids.
(author's abstract)
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