Endocrine and metabolic response to trauma in hypovolemic patients treated at a trauma center in Brazil.

Background: The metabolic changes in trauma patients with shock contribute directly to the survival of the patient. To understand these changes better, we made a rigorous analysis of the variations in the main examinations requested for seriously polytraumatized patients.

Methods: Prospective analysis of patients with blunt or penetrating trauma with hypovolemic shock, with systolic arterial pressure (SAP) equal to or lower than 90 mmHg at any time during initial treatment in the emergency room and aged between 14 and 60 years old. The following exams were analyzed: sodium, potassium, blood test, glycemia and arterial gasometry. The tests were carried out at intervals: T0 (the first exam, collected on admission) and followed by T24 (24 hours after admission), T48 (48 hours after admission), T72 (72 hours after admission).

Results: The test evaluations showed that there was a tendency towards hyperglycemia, which was more evident upon admission to hospital. The sodium in all the patients was found to be normal upon admission, with a later decline. However, no patient had significant hyponatremia; there was no significant variation in the potassium variable; the gasometry, low pH, BE (base excess) and bicarbonate levels when the first sample was collected and increased later with PO2 and PCO2 showing only slight variations, which meant an acidotic state during the hemorrhagic shock followed by a response from the organism to reestablish the equilibrium, retaining bicarbonate. The red blood count, shown by the GB (globular volume) and HB (hemoglobin) was normal upon entry but later it dropped steadily until it fell below normal; the white blood count (leukocytes, neutrophils and band neutrophil) remained high from the first moment of evaluation.

Conclusion: In this study we demonstrated the main alterations that took place in patients with serious trauma, emphasizing that even commonly requested laboratory tests can help to estimate metabolic alterations. Suitable treatment for polytraumatized patients with hypovolemic shock is a challenge for the surgeon, who must be alert to endocrinal and metabolic changes in his patients. Based on these alterations, the surgeon can intervene earlier and make every effort to achieve a successful clinical result.