THE metabolic impact of infectious and neoplastic disease states has long been known to clinicians.^{1 2 3 4} Invasive diseases may disrupt normal homeo-static mechanisms, both locally and systemically. For example, acute gram-negative infections frequently lead to profound metabolic acidosis and to biphasic changes in plasma glucose concentration, both seen in the context of hypotension, disseminated intravascular coagulation, and widespread tissue injury.^{5 6 7 8 9 10 11 12} Chronic infectious diseases, as well as neoplastic diseases, may provoke a severe wasting diathesis, in which negative calorie and nitrogen balance lead to death despite the absence of a large parasite or tumor burden.

It was once widely believed that invasive . . .