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November 1959

The Hyperglycemic Reaction of Alarm in Surgery

Author Affiliations

Minneapolis; New Haven, Conn.
Dr. Beckman, Assistant Professor, Cowles Foundation, Yale University, performed the statistical analysis.

AMA Arch Surg. 1959;79(5):815-819. doi:10.1001/archsurg.1959.04320110117019

Hyperglycemia is usually considered to be a manifestation of diabetes, and, when the routine preoperative laboratory determinations indicate no evidence of sugar in the urine, the surgeon is not usually atuned to the possibility of hyperglycemia as a postoperative complication.

Selye1 has indicated that any type of trauma will produce an initial hyperglycemia. This, he states, is especially pronounced in traumatic injuries to the intestine or in intraperitoneal procedures. Hemorrhage, burns, x-ray irradiation, anoxia, muscular exercise, and nervous or emotional stress, all, may produce a typical hyperglycemic response.

He has also observed that there may be a secondary hypoglycemia, particularly if there has been some fasting, starving, or malnutrition preceding the systemic stress.

It is known that diet and the state of nutrition of the patient preceding the systemic stress may greatly alter the carbohydrate metabolism response, for, when the glycogen stores are depleted, the secondary hypoglycemia develops more