During illness and trauma, metabolic changes include increased hepatic glucose production, decreased peripheral glucose utilization, and increased protein breakdown.

• A. Increased hepatic glucose production with increased peripheral glucose utilization
• B. Increased hepatic glucose production with decreased peripheral glucose utilization
• C. Increased hepatic glucose production, decreased peripheral glucose utilization, and increased protein breakdown
• D. Decreased hepatic glucose production with increased protein synthesis

Answer: (C)

In the stress response to illness or trauma, metabolism shifts toward a catabolic state driven by counterregulatory hormones. The liver ramps up glucose output to meet energy demands, so hepatic glucose production increases. At the same time, tissues become less efficient at taking up glucose due to insulin resistance and circulating catecholamines, so peripheral glucose utilization decreases. Proteins are broken down more rapidly to provide amino acids for gluconeogenesis and for acute-phase and repair processes, leading to increased protein breakdown.

The option that includes all three changes—increased hepatic glucose production, decreased peripheral glucose utilization, and increased protein breakdown—best matches this stress response. Other choices are inconsistent: one pair suggests increased peripheral glucose utilization, which doesn’t occur in this state; another omits the protein breakdown entirely, which is a hallmark of the catabolic response; and another proposes decreased hepatic glucose production with increased protein synthesis, opposite to the typical upregulation of glucose production and decreased protein synthesis seen in illness and trauma.