CONVALESCENCE: A STUDY IN THE PHYSIOLOGICAL RECOVERY OF NITROGEN METABOLISM AND LIVER FUNCTION

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Abstract
After herniorrhaphy, patients receiving excessive calories and low protein developed a smaller negative balance than those fed low protein and a smaller number of calories. Wastage of N occurred in subjects who received generous supplies of protein. Positive balances over a period comprising the day of surgery and the 5 succeeding days were obtained by feeding (a) excessive calories and protein, (b) maintenance calories 40% of which came from protein. The positive balance observed under (b) was augmented by am-bulation. Ambulation reduced but did not abolish negative balance observed under other conditions. Wastage of N followed immediately onset of infection and was relieved only by control of infection. The efficiency of the liver as measured by quantitative urobilinogen excretion was reduced maximally on the 3d postoperative day and returned to normal by the 6th day. Decrements in liver function were reduced by diets (a) high in protein and calories, (b) high in protein with maintenance calories.. Impaired liver efficiency was not improved on other diets. Urobilinogen excretion was not influenced by ambulation. It was increased by infections. Maximal bromsulfalein retention occurred on the day of operation and clearances were normal on 6th or later days. Alterations in diet did not affect this test. Decrements in liver efficiency with infections were shown by this test also. Excessive quantities of vits. exerted no protective influence on liver. After cholecystectomy, there were significant changes in the fasting blood sugars on the 4th postoperative day and in the Exton-Rose glucose tolerance test as late as the 10th day. The total serum proteins were significantly reduced on the 5th, and the serum albumin as late as the 11th postoperative day.