Effect of Hypoproteinemia on Susceptibility to Shock Resulting From Hemorrhage

Ravdin, I. S.; McNamee, H.G.; Kamholz, Jack H.; Rhoads, Jonathan E.

doi:10.1001/archsurg.1944.01230010504011

Cited by 22 publications

(2 citation statements)

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“…Replacement of the blood lost by physiological saline solution did not prolong life and appeared to interfere with natural compensation. In dogs, susceptibility to hemorrhagic shock has been found to be increased as much as 67 per cent if the animals have previously been made hypoprotein emic by means of plasmapheresis (138). The effects on fluid shifts within the body of withdrawing slightly more than a pint of blood from a normal adult subject and of transfusing a slightly smaller volume of red blood cells into anemic patients have been found to vary considerably from person to person without obvious explanation (139) .…”

Section: Body Fluid Changes In Shock and Allied Conditionsmentioning

confidence: 99%

Water Metabolism

McQuarrie¹

1945

Annu. Rev. Physiol.

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The literature of the current year contains an unusu. ally large number of reports dealing with the special problems which have arisen from the necessities of war waged on a global scale. Signifi cant additions have been made to our knowledge regarding the disturbances in fluid balance which result from such conditions as (a) extensive burns, (b) severe hemorrhage, (c) traumatic shock, (d) water and salt deprivation, and (e) exposure to extreme changes in environmental temperature and humidity� These receive special attention in the present review. Related topics, such as blood sub stitutes, renal secretion, and the special roles of proteins, electro lytes, and endocrine secretions, are dealt with as they relate to water metabolism. The general problem has been considered in two previous volumes of this publication (1,2). WATER DEPRIVATION AND DEHYDRATIONMuch of the older literature dealing with water deprivation has emphasized the effects of salt deficiency, because the usual situa tion in clinical medicine in which the subject is deprived of water is one of fasting or one in which the salt intake is deficient. Warfare on sea or land not infrequently subjects men to a',shortage of drink ing water while food is plentiful. Studies (3) have been made on men under conditions simulating the latter situation, in that they abstained from drinking water for three or four days while taking a "dry" diet which was adequate in protein, salt, and calories.There was no reduction in total plasma volume. The sodium of the serum rose while the potassium fell. The amount of urea produced by the body during the period of dehydration increased. The ex-. cretion of minerals did not keep pace with that of water, and the osmotic pressure of the plasma and of the whole body rose. This increase in osmotic pressure in dehydration may be the cause of death. Some potassium was lost from the cells, which contributed water to the extracellular compartment. The same authors (4) confirmed the findings of previous investigators (5) to the effect that the body may lose as much as 10 per cent of its weight from water deprivation without any appreciable reduction in blood 127 Annu. Rev. Physiol. 1945.7:127-162. Downloaded from www.annualreviews.org Access provided by Michigan State University Library on 02/19/15. For personal use only.Quick links to online content Further ANNUAL REVIEWS 128 McQUARRIE volume. No significant reduction in blood pressure or glomerular 'filtration rate is demonstrable during dehydration produced in this manner. Changes which characterize the urine of dehydration are due, therefore, to tubular activity alone. The effect of varying salt intake during water deprivation was found to be that of in creased plasma, which always led to a rise in urine volume, the ' , extra w�ter coming from tissue fluids (6) . On rehydration in stages, the subjects of the latter study who had been deprived of water for some' days on a diet containing five to fifteen grams of sodium chloride, showed a fall in urine volume when given some what l...

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Section: Body Fluid Changes In Shock and Allied Conditionsmentioning

confidence: 99%

Water Metabolism

McQuarrie¹

1945

Annu. Rev. Physiol.

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“…The manifestations of hypoproteinism are varied and most of them are undesirable in the surgical patient. Hypoproteinism may lead to any of the following: (a) diminished tolerance to blood loss with increased susceptibility to shock (b) lowered antibody production and lowered resistance to infection with impaired wound healing and tendency toward postoperative wound dehiscence, (c) delayed healing of fractures, liver dysfunction and fatty infiltration of the liver, (d) diminution of the plasma volume with an increase in interstitial fluid leading to generalized tissue edema which may effect gastro-intestinal anastomosis with delayed emptying, (e) weakness, lassitude, mental depression, and a diminution in the metabolic rate.0; 13,21 The nutritional requirements for the surgical patient are determined by: (a) the previous nutritional state of the patient, (b) the nature and severity of the pathologic abnormality, (c) the amount and character of the nutrient which is being lost from the body, and (d) the anticipated duration of the injury or disease. Approximately 1 Gm.…”

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confidence: 99%

Newer concepts of nutrition by the intravenous route

Artz¹

1959

Plastic and Reconstructive Surgery

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Preoperative and postoperative levels of plasma protein and amino acid in esophageal and lung cancer patients

Naini

Dickerson

Brown

1988

Cancer

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The metabolic changes following thoracic surgery in three groups of patients (esophageal cancer, lung cancer, and hiatus hernia) have been studied. Before operation patients with esophageal cancer, but not those with lung cancer, had significantly lower plasma total protein and albumin than patients with hiatus hernia. After surgery plasma albumin and total protein fell in both esophageal cancer and hiatus hernia patients, a development attributed to poor nutrition and restricted calorie diet in these two groups of patients respectively. With the exception of alanine and arginine in lung cancer patients, and free tryptophan in lung and esophageal cancer patients, the preoperative concentrations of all plasma amino acids were similar in both groups of cancer patients and in those with hiatus hernia. After operation the concentrations of glutamine, total tryptophan, alanine, glycine, and arginine fell sharply, whereas those of phenylalanine, lysine, valine, and leucine were slightly or not at all affected by surgery. The immediate postoperative fall of plasma free amino acids is thought to be due to the increased rate of gluconeo-genesis. The rise of free fraction of plasma tryptophan after surgery is related to the raised level of plasma free fatty acids and increased secretions of catecholamines, which is believed to follow surgery. Cancer 623355360, 1988. ATIENTS with esophageal cancer are frequently P malnourished as a result of reduced food intake, and their rehabilitation after surgery is often protracted. After esophagectomy fat absorption has been reported to be impaired.' These workers have also reported that after esophagectomy there is a rise in the excretion of the nitrogen in the feces. Although Wu and Bauer observed a relatively large increase in the plasma free amino acid levels to accompany tumor growth,2 recent studies by Norten et al., have shown that cancer patients with no or minimum body weight loss maintained their plasma free amino acid levels within normal range.3 Of the amino acids, the metabolism of tryptophan in malignant disease has attracted much interest in recent years. However, most of the studies on tryptophan metabolism have been carried out in patients with cancer of the bladder or It seemed to be of particular interest to study the metabolism of this amino acid in patients with esophageal cancer because its concentration in the plasma is reduced sharply by a reduced food intake and in particular

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Effect of Hypoproteinemia on Susceptibility to Shock Resulting From Hemorrhage

Cited by 22 publications

References 2 publications

Water Metabolism

Water Metabolism

Newer concepts of nutrition by the intravenous route

Preoperative and postoperative levels of plasma protein and amino acid in esophageal and lung cancer patients

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