Abstract
WE DO NOT PLAN to describe all the metabolic changes which may result from shock but to make some general statements which express our philosophy regarding this problem and then to discuss briefly a few specific points. A detailed discussion of this subject has been presented elsewhere.<sup>1</sup>We will use the term "shock" to connote a syndrome whose central feature is a precarious state of the circulation resulting in an overall insufficiency of blood flow. This insufficiency, when prolonged, leads to variable and inadequate perfusion and nourishment of certain organs and tissues and ultimately results in their dysfunction. Are there specific metabolic disturbances which determine "irreversibility" and which lead inexorably to death from shock despite any treatment? This is the point, of course, that Dr. Bing has raised regarding myocardial function.<sup>2</sup>This general question and its corollary, namely, to what extent and how rapidly can the metabolic defects
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