Renal and Hepatic Injury in Trypsin “Shock”. ∗

Abstract

Among the various features of the shock syndrome which develops in consequence of extensive tissue damage (burns, traumatic injuries, abdominal emergencies, severe infections, anoxia) are the negative nitrogen balance and the characteristic renal and hepatic changes. These, and other aspects of the shock syndrome have been attributed to or associated with a variety of “poisons” such as histamine, H-like substances, adenyl compounds, abnormal globulins, vasoconstrictor substances and numerous other products.

It has been demonstrated that the administration of proteolytic enzymes can induce the liberation of a variety of catabolic products, such as histamine 1 “slow reacting muscle stimulant substance” and adenyl compounds 2 and other pharmacologically active substances. Consequently, it occurred to us that with extensive tissue damage a proteolytic enzyme may be released locally, and it in turn be responsible not only for the production of toxic substances but also for an increased proteolysis and the consequent development of a negative nitrogen balance such as is observed in practically all types of shock. In order to test this hypotheses we studied the effects of injections of a known proteolytic agent.

The present preliminary report is concerned only with the renal and hepatic changes observed in rats and rabbits which received injections of a crude preparation of trypsin.† The intraperitoneal injection of a sterile 2% to 4% solution of trypsin in saline resulted in the development of the shock-like syndrome in from 3 to 36 hours, when from 5 to 10 cc was administered to rats and 10 to 20 cc to rabbits.