Changes in phosphate and carbohydrate metabolism in shock.

In recent years there have been many studies concerning the metabolic disturbances in shock secondary to injury, hemorrhage, and burns. Among the very marked changes reported are t,hose involving carbohydrates. The glycogen stores of liver (1) and muscle are reduced in rats shocked by limb injury, and these tissues are unable to replenish their glycogen stores after glucose administration. The blood sugar levels first increase and later are reduced to normal values or below. After glucose administration by mouth the blood sugar is greatly elevated, the high level persisting for many hours. The administration of insulin reduces the blood sugar level in these animals but does not improve the storage of glycogen in the liver (1). It will be shown in this paper that insulin does not prevent reduction in the glycogen level in untraumatized muscle in the shocked rats. These observations suggest that insulin may accelerate the utilization of sugar in peripheral tissues in these animals. Sacks (2) first showed that insulin increased the incorporation of P32 in adenosine triphosphate (ATP) and phosphocreatine (PC) in normal anesthetized cats. In view of this finding and because of the carbohydrate changes mentioned, a comparison was made between the effect of insulin on the uptake of P% in ATP and PC in shocked and in normal animals. Some workers (3) suggest that an important factor in the development of shock is the depletion of high energy phosphorus compounds essential for the metabolism of carbohydrate. To investigate this possibility a study of the labile phosphates in the muscle of shocked rats was made with radioactive phosphorus.