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March 1956

Metabolic Derangements Imperiling the Perforated Ulcer PatientV. Acceleration of Metabolic Rate and Altered Endocrine Activity

Author Affiliations

From the Department of Surgery, Harvard Medical School, and the Surgical Services, Massachusetts General Hospital.; Bilton Pollard Fellow, University College Hospital, London, England, and Recipient of Fulbright Travel Grant (Dr. Merrington).

AMA Arch Surg. 1956;72(3):439-444. doi:10.1001/archsurg.1956.01270210069011

INTRODUCTION  Weight loss is a charateristic sequel to ulcer perforation. Failure to meet the normal caloric demands by the parenteral route is undoubtedly in part responsible, but the possibility that elevation of the metabolic rate might also be a factor needs consideration. The depressing effect of malnutrition and debilitation on the metabolic rate has long been established,1 and in the preceding papers we have shown that the patients of this series were undernourished.* The effect of trauma on the metabolic rate in such a debilitating condition, however, has not been demonstrated. In a study of previously healthy persons suffering cutaneous burns, a striking and prolonged elevation of the metabolic rate has been observed.4 The rate returns to normal as the wounds heal. With a view to determining to what extent and for what length of time trauma and inflammation might change the caloric requirements of the patients with

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