Manipulating the metabolic response to injury

in this short review we will concentrate on just one of the features of the metabolic response to injury (classified as accidental trauma, injury or s epsis) which are collectively known as the 'flow' phase(1). These include a n increase in energy expenditure (hypermetabolism), changes in substrate ut ilisation (insulin resistance) and the focus of this chapter muscle wasting or catabolism. It is recognised that the three features are interrelated, for example insulin is believed to be an important factor in controlling am ino acid flux in skeletal muscle(2) and increasing environmental temperatur e which may reduce flow phase hypermetabolism(3) has been shown to reduce p ostoperative nitrogen excretion (a marker of protein catabolism)(4). Howeve r, we will concentrate on muscle wasting and refer the reader to other revi ews on insulin resistance(5) and metabolic rate(6).