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February 1956

Metabolic Derangements Imperiling the Perforated Ulcer Patient: IV. 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