Effect of intravenous fluid volumes on the adrenal glucocorticoid response after burn injury in swine

Belinda I. Gomez, Celestine He, Tony Chao, Michael A. Dubick, David M. Burmeister

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Severe thermal injury induces metabolic and physiological stress, prompting a disruption in the hypothalamicpituitary-adrenal axis. The objective of this study was to evaluate potential confounding effects of Lactated Ringer's (LR) resuscitation on adrenal damage and cortisol production following burn. Anesthetized swine were instrumented with jugular catheters and sustained 40% TBSA burns from brass probes heated to 100°C. Animals recovered to consciousness and received IV fluid resuscitation with LR at two different volumes: 15 ml/kg/d (limited volume [LV], n = 6) or 2 ml/kg/%TBSA/d (modified Brooke [MB], n = 6). Nonburned animals (Sham) were both oral and IV fluid restricted (S-FR, n = 4) to induce stress. Computed tomography (CT) angiographies were performed at baseline (BL) and 48 hours postburn, while blood and urine samples were collected at BL, 6, 24, and 48 hours postburn, with euthanasia at 48 hours for adrenal harvesting. Urinary cortisol was elevated following burn/ surgery in all animals and returned back to BL in S-FR (404 ± 48 pg/mg creatinine) but not MB (1332 ± 176 pg/ mg creatinine; P = .005) or LV (1223 ± 335 pg/mg creatinine; P = .07) by 48 hours. Gene expression of cleavage enzymes (3β-HSD, CYP17, CYP11, and CYP21) along the cortisol synthesis pathway showed minimal changes. Adrenal apoptosis (Terminal deoxynucleotidyl transferase dUTP nick-end labeling [TUNEL] staining) was greatest in the MB group (P ≤ .01) when compared to S-FR, partly due to elevations in c-Jun N-terminal kinase. Adrenal hemorrhaging was also greatest in MB animals, with no differences in tissue volume or wet-to-dry ratio. However, tissue levels of cytokines IL-1β, IL-10, and IL-12 were greatest in LV. Burn injury elevates urinary cortisol and compromises adrenal gland integrity, which is affected by IV fluid volume.

Original languageEnglish (US)
Pages (from-to)652-660
Number of pages9
JournalJournal of Burn Care and Research
Volume39
Issue number5
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Glucocorticoids
Hydrocortisone
Swine
Creatinine
Physiological Stress
Wounds and Injuries
Burns
Resuscitation
Steroid 17-alpha-Hydroxylase
Euthanasia
DNA Nucleotidylexotransferase
JNK Mitogen-Activated Protein Kinases
Interleukin-12
Adrenal Glands
Consciousness
Interleukin-1
Interleukin-10
Neck
Catheters
Hot Temperature

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

Cite this

Effect of intravenous fluid volumes on the adrenal glucocorticoid response after burn injury in swine. / Gomez, Belinda I.; He, Celestine; Chao, Tony; Dubick, Michael A.; Burmeister, David M.

In: Journal of Burn Care and Research, Vol. 39, No. 5, 01.01.2018, p. 652-660.

Research output: Contribution to journalArticle

Gomez, Belinda I. ; He, Celestine ; Chao, Tony ; Dubick, Michael A. ; Burmeister, David M. / Effect of intravenous fluid volumes on the adrenal glucocorticoid response after burn injury in swine. In: Journal of Burn Care and Research. 2018 ; Vol. 39, No. 5. pp. 652-660.
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