J.Jpn. Surg. Soc.. 87(9): 956-959, 1986

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Report on the annual meeting

METABOLIC DETERIORATION IN SHOCK STATE AND ITS MODULATION

Apparently shock progresses through two major stages : 1) an extracellular stage (fluid disturbances) and 2) an intracellular stage (metabolic disorders). The extracellular stage includes alteration in neuroendocrine regulation and circulation of systemic fluid.
The initial cellular reaction against the deleterious effects of shock-inducing stimuli elevates the energy-producing capacity so that the cell is able to sustainits normal function. Several endocrine events are fundamentally important as triggering factors for this kind of reaction. As the shock state advances, cellular metabolism deteriorates progressively and cellular energy is exhausted. Depression of intracellular cAMP may induce cellular metabolic unresponsiveness to hormonal stimuli. Consistent degradation of high-energy substances, extreme deviation of the redox state in the NAD^＋-NADH system, and decrease of endogenous key substances such as L-carnitine ultimately may lead to a standstill of cellular enzymatic reactions. Methods intended to sustain cellular membrane and enzymatic system may offer the best contribution to the improvement of shock therapy.

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