Which of the following is a sign of the flow phase after a burn injury?

• A. Decreased insulin secretion
• B. Elevated glucagon
• C. Decreased gluconeogenesis
• D. Decreased body temperature

Answer: (B)

During the flow phase after a burn, the body shifts into a hypermetabolic, catabolic state driven by increased counterregulatory hormones such as glucagon, catecholamines, and cortisol. This hormonal surge pushes the liver to produce more glucose and fuels breakdown of fats and proteins to meet the high energy and substrate demands for healing and immune function.

Elevated glucagon fits this pattern because glucagon stimulates hepatic gluconeogenesis and glycogenolysis, raising blood glucose to supply tissues with energy during this stressed state. This rise in glucose output is a hallmark of the flow phase’s metabolic drive.

In contrast, options suggesting decreased insulin secretion, decreased gluconeogenesis, or decreased body temperature do not align with the flow phase: insulin action is often impaired (resistance) despite possible relative increases, gluconeogenesis is upregulated rather than downregulated, and the flow phase is typically associated with hypermetabolism and fever, not hypothermia.