The Nutritional Requirements for Nitrogen Balance in Surgical Patients During the Early Postoperative Period 1

Abstract

The role of protein nutrition in the convalescence of surgical patients has been emphasized by many authors during the past 15 years, and much of this work has recently been ably reviewed by Lund (1). The observations of Cuthbertson (2), confirmed by Howard and his co-workers (3), that fractures of long bones resulted in a marked negative nitrogen balance which could not be overcome by substantial increases in the protein intake, raised certain questions regarding the possible effects on nitrogen requirements and nitrogen balance of extensive surgical operations. It seemed important to know how soon after operation a positive nitrogen balance could be re-established, and what levels of nitrogen and caloric intake would be required to accomplish this.Many of the previous concepts of the protein nutrition of surgical patients have been based on changes which were found in the serum protein concentration at different periods. It is generally acknowledged that the use of such data may lead to erroneous conclusions, but they have continued to be used by many investigators chiefly because of the difficulties in carrying out the more informing balance studies. In this project, additional technical aid made it possible for us to carry out both types of study. Our results indicate that the serum protein concentration may, at times, increase in spite of a negative nitrogen balance during the period of study.It has also been possible to compare the effectiveness of whole protein with various preparations

The Effect of Parenteral Feeding on the Postoperative Protein Metabolism

“…Mulholland et al (1943) and Co T u i et al (1944) were able to produce positive nitrogen balance in th e early postoperative period by high nitrogen (20 g/day) and high calory (4000 cal/day) intake in th eir gastrectom ized patients. Riegel et al (1947) and Troell and Wretlind (1961) achieved the same result by lower nitrogen b u t higher calory intake. Holden et al (1957) found th a t postoperative nitrogen loss is due to poor intake of food.…”

Total parenteral nutrition, an ally in the management of patients with intestinal failure and malnutrition: a long‐term view

“…The excess nitrogen requirements for large gastrointestinal surgeries were noted. 5 In hypoalbuminemic patients, a reduction in antibody production was measured and responded to supplementation with oral lactalbumin or casein hydrolysate, although the response was not equivalent to that of well-nourished patients. 4 A descriptive study of enhanced infectious and noninfectious complications in hospitalized patients with hypoproteinemia conducted by Rhoads and corroborated by Brunschwig at the University of Chicago 6 steeled Rhoads' determination to find adequate ways of feeding malnourished surgical patients.…”

“…14 Perhaps his greatest contribution was his persistence and dedication to the goal of IV nutrition despite the many technical and 376 SPENCER AND COMPHER Vol. 27,No. 5 scientific roadblocks and the considerable obstacle presented by the general belief of the medical community that this was a futile and perhaps foolish quest.…”

“…62 The AGA 378 SPENCER AND COMPHER Vol. 27,No. 5 position paper questions the use of home TPN when the projected life expectancy, usually because of active cancer, is Ͻ3 months' duration.…”

Maintenance of metabolism during intensive patient care

“…This view probably originated frQm tfie early observations on the metabolic response t& trauma which revealed increased nitrogen losses in the urine (Cuthbertson, 1930) which could not be prevented by eating a diet rich in first-class protein (Cuthbertson, 1942). If measures are taken to provide food over and above the patient's spontaneous appetite, it is possible to reverse the negative nitrogen balance which is a feature of the metabolic response to surgery (Riegel et al, 1947) or burns (Meyer, Hirschfeld & Abbott, 1947).…”