Abstract
Blood ketone bodies and plasma NEFA have been estimated before, during, and after operation in an attempt to determine when overall body metabolism starts to use fat in the quantities indicated by clinical experience. It is concluded from the data that the carbohydrate reserve is depleted earlier in patients awaiting operation than would be the case in simple starvation. The failure of blood ketones and plasma NEFA to show a sustained rise post-operatively (as found in fasting subjects) is thought to be due to the avidity of the tissues for these energy substrates, so that increased utilisation outstrips increased production during the first day after operation. There would seem to be a place for intravenous fat emulsions in post-operative therapy in selected cases where there is evidence of insufficient endogenous caloric reserve.
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