The flow phase of the stress response follows the ebb phase. Typically, it commences after about 48 hours. There is a marked increase in the basal metabolic rate in proportion to the extent of the injury. For example, in burns the BMR is proportional to the percentage total body surface area burned.
The cardiac output is increased and the circulation becomes hyperdynamic. The core temperature increases, possibly due to the actions of tumour necrosis factor alpha and interleukins 1 and 6.
There is increased adrenaline and noradrenaline secretion. Glucagon secretion increases producing a relative glucose intolerance. Insulin secretion increases but there is a relative resistance to its presence. There is increased lipolysis. Glucocorticoid secretion is elevated.
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