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November 1955

Metabolic Derangements Imperiling the Perforated Ulcer PatientI. The Dehydration and Fluid Shifts

Author Affiliations

From the Department of Surgery, Harvard Medical School, and the Surgical Services, Massachusetts General Hospital.

AMA Arch Surg. 1955;71(5):669-681. doi:10.1001/archsurg.1955.01270170027005

Abundant evidence has accumulated in recent years to indicate that surgical diseases and operations give rise to widespread and significant metabolic derangements.* A number of conditions have been investigated, and a general pattern is emerging, but the differences between individual conditions or operations which may be of significance to therapy are not fully apparent. Only in a few areas, such as burns and fractures, has a single entity been studied repeatedly, and in both of these extensively investigated conditions the variations within the group are wide. To date the experience with the metabolic changes of surgical disease might be called horizontal. Five years ago it occurred to us that it would be valuable to take a more vertical view, studying one entity sufficiently often to encounter most of the variables. We hoped this type of investigation would enable us to describe with authority any common pattern which emerged and would

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