What is the primary effect of severe acute trauma on protein binding?

Severe acute trauma can lead to a significant decrease in plasma proteins, particularly albumin and alpha-1 acid glycoprotein. These proteins are crucial for drug binding in the bloodstream; they help regulate the distribution of drugs and the balance of free (active) versus bound (inactive) drug forms. When there's a reduction in these plasma protein levels, it results in lower protein binding capacity, which increases the fraction of unbound or free drug in circulation. This can elevate drug efficacy and toxicity, as the unbound drug is the pharmacologically active form. Therefore, the primary effect of severe acute trauma is the decrease in plasma proteins, leading to altered pharmacokinetics of various medications.