Alterations in Fuel Metabolism in Critical Illness

  • K. Patrick Ober
Part of the Contemporary Endocrinology book series (COE, volume 4)


Glucose has an essential function as the fundamental energy source for the brain. This critical fuel requirement creates a need for a consistently available and uninterrupted supply of glucose. Because of the crucial need for glucose, an intricate homeostatic system has evolved to assure adequate availability of glucose at all times: Postabsorptive (fasting) levels of plasma glucose are generally kept within the fairly narrow range of 60–100 mg/dL or 3.3–5.6 mM/L (1). This stability is maintained even under the disruptive circumstances of caloric deprivation and increased energy requirements, which occur with severe trauma, febrile illnesses, and other catabolic states. The maintenance of adequate serum glucose levels is, in fact, a paramount goal of the stress response, and the increased secretion of “stress hormones,” such as cortisol, catecholamines, and growth hormone, contributes to the provision of consistent glucose availability; if the system for glucoregulation is going to be off-target, it will err by promoting an elevation of glucose levels, rather than risking the potential catastrophe of an inadequate glucose supply. Thus, an elevation of the serum glucose level is the most common clinical disorder of glucose metabolism in critical illness, as discussed in detail in Chapter 10. However, some patients with critical illness will have a failure in the life-sustaining system for maintaining serum glucose levels; this inability to provide an adequate energy supply can lead to severe dysfunction of many organs, and it ultimately may cause the demise of the affected individual.


Serum Glucose Level Counterregulatory Hormone Hepatic Glycogen Store Counterregulatory Response Neuroglycopenic Symptom 
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  • K. Patrick Ober

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