[The catabolic patient]

Trauma and stress can cause characteristic changes in metabolism: raised lipolysis and reduced glucose tolerance as well as major renal nitrogen losses are manifestations of a postoperative or posttraumatic excess of catabolism over anabolism. Excess catabolism is caused by immobilisation and inadequate oral or parenteral nutrition. Wasting in seriously ill patients for intensive treatment. Priority must be given to the prevention of insufficiencies of organs and systems, and to the elimination of stress factors. It is only then that mobilisation and the administration of calories and nitrogen will restore a normal anabolism-catabolism balance.