Failure of postoperative infection to increase nitrogen excretion in patients maintained on peripheral amono acids

Fourteen well-nourished patients undergoing elective major surgery were maintained on intravenous, dextrose-free isotonic (3%) amino acid solution postoperatively. Seven patients developed fevers greater than 100 F due to a variety of mild infective complications. While all patients developed a negative nitrogen balance postoperatively in this ketonemic state, infection did not appear to increase nitrogen loss. This is in striking contrast to the response observed in the fed state. Adaptation to starvation, particulary the effect of ketones on muscle metabolism, would appear to reduce significantly the nitrogen loss during infection.