Much of the tremendous advance in surgery in the past decade or more has been achieved because of the recognition of various biochemical deficiencies and their correction by appropriate replacement therapy. Loss of water, loss of electrolyte, loss of plasma have all been studied and now are corrected rapidly and effectively by the parenteral route. Indeed, with the purification of vitamins, many of them can also be administered parenterally and replacement therapy carried out along with the intravenous injection of saline solution, dextrose and plasma.
Nitrogen loss after operation has been largely overlooked even though such loss, unless replaced immediately, means depletion of tissue protein. More important, the loss leads to hypoproteinemia, which, if severe, produces many serious clinical manifestations. Especially significant, therefore, are the recent studies of Brunschwig and his co-workers1 at the University of Chicago. They observed the nitrogen loss by 41 patients who were operated on