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Abstract
Much improvement has been made in mortality rate following major operations during
the past two or three decades, but malnutrition remains a difficult problem to correct,
and deserves much more attention on the part of the surgeon. For years, we have been
aware of the increased nitrogen excretion after operation. This negative nitrogen
balance appears to be closely related to the alarm reaction of Selye. Experiments
show that with early feeding after operation, the negative nitrogen balance can be
diminished but not completely obliterated.
The deleterious effects of bed rest on nitrogen balance are not fully appreciated
by the surgical profession. We must make sure that no elective surgery is performed
on a patient who has been immobilized in bed for a few days prior to the date of operation.
Proteins will be used as fuel unless carbohydrates or fat is available for use by
the body. Plasma protein levels are very important in determining the state of protein
metabolism, but, unfortunately, may be very misleading. In dehydration they will be
abnormally high. On other occasions, they may be normal, whereas insufficient food
intake may be known to exist for several weeks preceding examination. It is rather
obvious that the blood stream draws upon protein deposits in an effort to keep the
plasma level as nearly normal as possible. The causes of protein deficiency are innumerable.
The important ones are inadequate intake, trauma, hepatic insufficiency, ulcer (external
or in intestinal tract), diarrhea, fistulas, infection, intestinal distention, transudates,
and exudates.
If a patient requiring a major operation has a history of inadequate food intake for
a period shortly before operation, all possible effort must be made to correct this
malnutrition. Obviously, forced feedings by mouth are desirable. Occasionally, feedings
by nasal tube are more effective than oral intake. Intravenous therapy including glucose
and amino acids must be utilized wherever possible. If a patient has lost 10 or 15
pounds in fifteen or twenty days preceding operation, intense effort must be made
to gain part of that back. Blood transfusions are very effective in improving hypoproteinemia.
Intravenous plasma is likewise very effective, but expensive.
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Article info
Publication history
Received:
February 1,
1955
Identification
Copyright
© 1955 Published by Elsevier Inc.
