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Table 1 Metabolic changes after major trauma.

From: Metabolic changes after polytrauma: an imperative for early nutritional support

"Ebb" phase (hours) "Flow" phase (days to weeks)
Decreased body temperature Increased body temperature
Decreased oxygen consumption Increased oxygen consumption
Lactate acidosis Negative nitrogen balance
Increased stress hormone levels Increased stress hormone levels
Decreased insulin levels Normal to increased insulin levels
Hyperglycaemia, insulin resistance Hyperglycaemia, insulin resistance
Gluconeogenesis Gluconeogenesis
Increased substrate consumption Proteinolysis ("autocannibalism")
Hepatic acute-phase response Lipolysis
Immune activation Immunosuppression