Postaggression Syndrome

The generic term post-aggression syndrome , also stress metabolism , post-aggression metabolism or absorption metabolism , summarizes the pathophysiological changes that occur in the organism as part of trauma such as injuries or operations.

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Background and shutter

This stereotypical reaction has developed in the course of evolution and increases the likelihood of young individuals surviving in life-threatening stressful situations. The blood pressure is maintained and the body continues to be supplied with blood if there is a loss of blood / fluid. Furthermore, a catabolic metabolic situation arises for the provision of energy sources. This serves acutely for fight / flight reactions and in the longer term for tissue repair processes.

The triggers of post-aggression syndrome, which are mutually reinforcing, are pain, fear, tissue damage, and fluid loss.

Pathophysiology

During this process a number of hormones are released. The most important are the catecholamines adrenaline and noradrenaline, glucagon , cortisol and growth hormones. In addition to increasing the heart rate , cardiac output and blood pressure, these serve to provide the body with energy (which it needs for the fight / flight response described above). He draws on all three nutrients . There is an increase in proteolysis (protein breakdown ), an increase in lipolysis (fat breakdown) with an increase in free fatty acids in the blood and an increase in gluconeogenesis (glucose formation, e.g. from lactate and certain amino acids) and glycogenolysis (glycogen breakdown).

Closely related to this is a decrease in the release of insulin and, at the same time, more difficult glucose utilization . This leads to an increase in blood glucose concentration . Glucose is one of the body's fastest sources of energy.

In addition, there is a lack of blood volume due to blood loss and loss of body fluid to the outside or into the so-called third space ( edema , intestine ). Stress hormones (see above) activate the renin-angiotensin-aldosterone system , which results in the retention of sodium and water and the loss of potassium , and in the release of ADH , which in turn leads to the retention of water and this in turn to the stabilization of blood volume and blood pressure leads. In addition, acute phase proteins are released .

course

Post-aggression syndrome has four stages:

• The injury phase lasts two to three days. The person concerned feels pain, has decreased interest in the environment, is in a depressed mood and feels thirsty.
• During the turning phase , which lasts two to three days , there is an improvement with normalization of vegetative functions such as pulse, blood pressure, respiratory rate, temperature, hunger and peristalsis (bowel movement).
• The anabolic phase lasts two to three weeks. The mood is normalized and there is an increased need for sleep and a positive nitrogen balance (protein build-up )
• Finally, during the convalescence phase , weight gain and physical performance are restored.

Prophylaxis and therapy

Older people in particular are optimally prepared before treating the syndrome. Treatment can be through pain therapy , sedation or volume therapy ( infusions ); if necessary, blood substitutes and protein are given to the patient. Furthermore, the electrolyte and acid - base balance is balanced. After therapy, the patient is monitored.

Complications

Decompensation, shock, or cardiac arrest may occur during the reaction .

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