Effects of total pancreatectomy in a patient with diabetes

摘要: Abstract Pancreatectomy, the completeness of which was established at autopsy, performed for carcinoma in a patient who already diabetic and had chronic diarrhea. The stomach, duodenum, spleen, left adrenal were also removed. For approximately three months remained sufficiently good condition to permit metabolic studies. Loss pancreas led marked increase diarrhea, daily fecal weight on one occasion being 5,580 Gm., even though receiving powdered large amounts. Atropine more effective than pancreatin controlling volume its effect augmented by sharp reduction dietary fat. Intestinal absorption both fat protein, less normal before operation, strikingly diminished thereafter. loss nitrogen feces (12.3 Gm. daily) accompanied relatively low urinary 4.68 per day. Analyses food excreta showed slightly positive calcium phosphorus balance, despite severe Extirpation not followed any requirement insulin which, with diet containing 400 carbohydrate, averaged about 40 units Sensitivity marked, experiencing frequent hypoglycemic reactions. With constant feedings every two hours supply derived from injection protamine zinc insulin, blood sugar exhibited definite diurnal pattern, lowest values occurring during night. phenomenon is presumably related rhythmic variations activity liver. When maintained injections crystalline day, last dose given supper, fasting sugars essentially normal. This contrary usual finding severe, spontaneous diabetes. Also variance behavior such patients response present case intravenously administered glucose, resultant curves "diabetic" might be expected. postabsorptive respiratory quotients varied .77 .80, are considerably higher those totally depancreatized dogs or severely human beings. Of total calories mixture, 27.7 cent came 9.4 protein 62.9 withheld, DN ratio urine 2.42 3.59 occasions, respectively. Permanent withdrawal resulted within six days death coma. Values serum amylase fell levels shortly after but later returned One month removal pancreas, lipids declined 20 30 below immediate postoperative value, they never reached subnormal levels. Pancreatectomy produced no striking changes carbon dioxide, pH, Cl, Na, K, Ca, P, plasma proteins. considerable nutriment through diarrhea may explain certain apparent differences between diabetes this disease ordinary patients.