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Metabolic and hormonal changes after surgery: hyperinsulinaemia during glucose infusion
Author(s) -
SOERJODIBROTO W. S.,
HEARD C. R. C.,
JAMES W. P. T.,
FEW J. D.,
BLOOM S. R.
Publication year - 1977
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.1977.tb01654.x
Subject(s) - nefa , medicine , endocrinology , glucagon , insulin , nitrogen balance , hormone , excretion , urinary system , pancreatic hormone , chemistry , insulin resistance , nitrogen , organic chemistry
. Serial measurement of blood and urinary hormones and metabolites were made on eleven patients before and after abdominal surgery. A complete nitrogen balance on three patients showed that after the operation there was a net loss of nitrogen equivalent to about 50 g protein per day for 5–6 days. This period coincided with elevated fasting plasma levels of glucagon and non‐esterified fatty acids (NEFA), and elevated 24 h urinary excretion of free cortisol and 17OH‐corticosteroids; total plasma amino acid levels were diminished but the concentrations of the branchedchain amino acids were increased. Fasting plasma concentrations of glucose, insulin and cortisol were increased only on day 1 after the operation. A 2 h glucose infusion (0.35 g kg ‐1 h ‐1 ) was carried out on each patient on day 1 and on ‘recovery’ (9–21 days). The mean glucose levels reached (12.1 mmol and 10.3 mmol/l, respectively) did not differ significantly; they were much higher than in young normal subjects (6.1 mmol/l). Glucose infusions, both on day 1 and on ‘recovery’ resulted in significant depression of glucagon and NEFA levels. Plasma insulin levels during glucose infusion were significantly higher on day 1 than on ‘recovery’, suggesting improving sensitivity to insulin. Possible explanations are discussed. Attention is drawn to the practical implications of the choice of nutrients in the parenteral nutrition of postoperative patients.