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February 1956

Metabolic Derangements Imperiling the Perforated Ulcer PatientIV. Derangements of Nitrogen Metabolism and the Nitrogen Deficit

Author Affiliations

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

AMA Arch Surg. 1956;72(2):336-345. doi:10.1001/archsurg.1956.01270200152027

INTRODUCTION  It is generally accepted that trauma disturbs nitrogen metabolism.* Reported first as a sequel of a fracture, the disturbance follows a burn and a variety of operations. The obvious manifestation of this disturbance is an increased excretion of nitrogen in the urine. After minor trauma, this excretion persists for only a few days; after severe trauma, for four weeks or longer. Unless this abnormal excretion can be counterbalanced by an increased intake, the patient suffers a nitrogen deficit. To a previously healthy person a transient deficit may be of little moment, but to those who have been ill and debilitated the deficit may lead to a crippling nitrogen depletion.Questions regarding three aspects of the disturbance in nitrogen metabolism prompted this study in the patient with the perforated peptic ulcer: the extent of the disturbance, the effect of any deficit upon the clinical course, and the management of such

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