Though protein nutrition is important in any field of medicine it is of special concern to the surgeon. The surgeon is often charged with the care of a depleted patient who must undergo a major surgical procedure as part of his treatment. In many instances obstructing or inflammatory lesions of the gastrointestinal tract preclude adequate oral alimentation. Superimposed on an accumulated nitrogen deficit may be losses of protein through draining wounds and sinuses, into areas of inflammation and into traumatized tissues, and losses from hemorrhage; the "reaction of injury" involving an ill understood increase in the rate of protein catabolism often inevitably complicates the problem for the surgeon. Furthermore, the hazards of protein deficiency during convalescence from surgical operation have come into clearer recognition as the subject has received closer study.
Despite the fundamental contributions of numerous investigators of protein metabolism and the adaptation of basic facts to clinical problems,
STEWART JD, HALE HW, SCHAER SM. MANAGEMENT OF PROTEIN DEFICIENCY IN SURGICAL PATIENTS: Intravenous and Intrajejunal Injections. JAMA. 1948;136(16):1017–1021. doi:10.1001/jama.1948.02890330007002
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