Metabolic changes following trauma

1. Shock - blood loss, poor blood flow, low Oxygen supply - catecholamines

2. Hypercatabolism - increased basal metabolic rate, anaerobic metabolism, excessive breakdown of fat and protein - $\uparrow$ cortisol, glucagon $\downarrow$ GH, Insulin

3. Anabolic phase - macromolecule synthesis, onset of recovery, improved appetite - risk of refeeding syndrome