Metabolism in Surgical Patients
Courtney M. Townsend JR., MD, in Sabiston Textbook of Surgery, 2022
Biology of Acute Catabolism: Mineral and Antioxidant Alterations
Along with changes in macronutrients, inflammatory responses cause alterations in micronutrients (vitamins and minerals) from baseline physiology (Table 5.8).9,19 The most prominent of these responses is anemia, as IL-1 and TNF cause reduction in blood iron and zinc content.9,15,30 Since many microorganisms use iron and zinc as growth factors, it is speculated that these acute decreases in serum concentrations are part of protective immune responses against invading microorganisms.9,15,30 Moreover, these elements are decreased in serum, but they are not excreted from the body; they are stored in the liver and can be used again in cellular metabolism for the host after infection has resolved.9,15,30 While serum concentrations of both zinc and iron decrease, plasma copper concentrations rise because of the significant increase in ceruloplasmin, an additional acute phase protein.9,15,30 Deficiencies of water-soluble vitamins may also be identified, as diuresis begins during the resolution of the acute phase of stress.9,15,30