Abstract
Different types of shock induce distinct metabolic changes. The myocardium at rest utilizes free fatty acids as its primary energy source, a mechanism that changes to aerobic glycolysis during sepsis and is in contrast to hemorrhagic shock. The immune system also uses this mechanism, changing its substrate utilization to activate innate and adaptive cells. Cardiomyocytes share a number of features similar to antigen-presenting cells and may use this mechanism to augment the immune response at the reversible expense of cardiac function.
Highlights
Different types of shock induce distinct metabolic changes
Chew and colleagues [1] in the previous issue of Critical Care used microdialysis to measure metabolites within cardiac and skeletal muscle during endotoxemia. They found that endotoxemic shock induces metabolic changes in cardiac and skeletal muscle cells that do not occur during hemorrhagic shock
While lactate increased in both forms of shock, pyruvate levels increased during endotoxemia, suggesting that elevated lactate levels were not due to anaerobic metabolism, in accord with the observations of Cunnion and colleagues [2]
Summary
Different types of shock induce distinct metabolic changes. The myocardium at rest utilizes free fatty acids as its primary energy source, a mechanism that changes to aerobic glycolysis during sepsis and is in contrast to hemorrhagic shock. Cardiomyocyte metabolism changes in response to different types of shock. They found that endotoxemic shock induces metabolic changes in cardiac and skeletal muscle cells that do not occur during hemorrhagic shock.
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