Metformin, commonly recognized as a long-term medication to reduce morbidity and mortality, typically isn’t associated with critical care settings. In fact, the prevailing belief is to withhold metformin in such contexts due to the risk of lactic acidosis. However, recent studies suggest a novel and effective application of metformin in treating burn victims, offering new hope in critical care medicine.
The Challenge of Acute Metabolic Stress in Burn Victims
Severe burns trigger significant acute metabolic stress, often leading to death from devastating infections, hypovolemia complications, or extreme tissue catabolism. Traditional strategies to combat acute cachexia include anabolic steroids and appetite stimulants to prevent severe muscle loss, which can result in cardiorespiratory arrest. Interestingly, metformin has emerged as a promising addition to these pharmacological interventions in specialized burn units.
How Metformin Ameliorates Catabolism in Burn Victims
Reduction of Hyperglycemia
Metformin significantly decreases blood glucose levels, reduces glucose production, and enhances glucose clearance. During trauma and severe burns, cortisol is released at supra-physiological levels, leading to hyperglycemia. This extreme blood sugar level impedes proper tissue regeneration, a critical issue in large skin burns. High plasma glucose concentrations bind to proteins and enzymes, reducing their efficiency and generating more reactive oxygen species (ROS). These free radicals further damage tissues, exacerbating the need for repair. Additionally, high glucose levels deplete NAD+, a crucial molecule in neutralizing ROS, thereby limiting the body’s ability to combat oxidative stress.
Improvement in Insulin Sensitivity
Metformin enhances insulin sensitivity through AMPK upregulation, which dovetails with its role in reducing hyperglycemia. Increased insulin sensitivity lowers blood sugar levels and inhibits protein breakdown. AMPK activation also reduces inflammation by decreasing C-reactive protein and interleukin-6 levels while shifting metabolism to fatty acid oxidation. These combined effects make metformin an unexpected yet effective treatment in acute burn scenarios.
Overcoming the Catabolic Nature of Metformin
Metformin is generally known for its catabolic properties, often inducing weight loss by signaling the liver that less energy is available. This characteristic might seem counterproductive in treating burn victims. However, the benefits of metformin in managing hyperglycemia and improving insulin sensitivity outweigh its catabolic nature, providing a legitimate use case in critical care settings.
Conclusion
The integration of metformin into the treatment regimen for burn victims marks a significant advancement in critical care medicine. By addressing hyperglycemia and enhancing insulin sensitivity, metformin helps mitigate the extreme catabolic state experienced by burn victims. This novel application underscores the evolving understanding of metformin’s potential, offering a beacon of hope in improving survival rates and recovery outcomes in severe burn cases.
