TIME-COURSE OF THE EARLY PITUITARY-ADRENAL AND METABOLIC - RESPONSES TO ACCIDENTAL INJURY

We have made serial measurements of the plasma adrenocorticotrophic ho rmone (ACTH), cortisol, glucose, lactate, glycerol, nonesterified fatt y acid (NEFA), and beta-hydroxybutyrate concentrations in 14 recently injured patients, We took 6 to 9 blood samples at about 20-minute inte rvals from each patient within the first 3 hours after accidental inju ry of moderate severity (Injury Severity Score of 9 to 13), Plasma ACT H varied greatly both with time and between patients; in the majority, it fell throughout the sampling period and in the others, the pattern varied, The changes in plasma cortisol were mostly appropriate to tho se in ACTH. Plasma glucose and glycerol did not change systematically with time, In contrast, plasma lactate fell, and plasma NEFA, beta-hyd roxybutyrate, and the NEFA:glycerol ratio rose, throughout the samplin g period. Analysis of variance for these data showed that time after i njury made a contribution that was highly significant, although smalle r than that arising from differences between patients.