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October 1962

Citrate Metabolism During Surgery

Author Affiliations

From the Departments of Surgery and Medicine, Western Reserve University, Highland View Hospital, and the University Hospitals of Cleveland.

Arch Surg. 1962;85(4):557-563. doi:10.1001/archsurg.1962.01310040029004

All postoperative patients are temporarily diabetic, at least with respect to the assimilation of exogenous glucose.1 Generally, the severity of the change in glucose tolerance is proportional to the magnitude and extent of the operative procedure.2 Unless the postoperative period is complicated by an infection or by conditions that preclude optimal alimentation, a normal tolerance for glucose is reestablished usually within a week. In marked contrast, there is no impairment in the rate of assimilation of fructose either during or after surgery in comparison with the preoperative rate.1

One interpretation of these findings is that surgical stress has some effect on factors responsible for the cellular transport of glucose, but it has no effect on the permeability of the cell wall to fructose. Another interpretation is that stimulation of the pituitary-adrenal axis results in a humoral inhibition of glucokinase with a consequent delay in the entrance of

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