We serially measured the proton nuclear magnetic resonance spectra of the urine of intraoperative patients over time to assess their potential use for rapid multicomponent analysis of cellular metabolites. Within a few minutes, the spectra provided signals of many low molecular weight urinary metabolites, including amino acids, ketone bodies, lactate, and glucose. The proton magnetic resonance spectra of the urine of most of the intraoperative patients showed large increases in urinary excretion of alanine, ketone bodies, and lactate and/or glucose, confirming alterations in energy substrate-endocrine relationships during the perioperative period. These metabolic changes appeared to be roughly proportional to the degree of surgical stress, but they were not consistent among patients who underwent the same operation. The study suggests that routine intraoperative metabolic monitoring is necessary to prevent critical metabolic disorders and that proton nuclear magnetic resonance spectroscopy of urine may meet this need by allowing rapid multicomponent analysis of cellular metabolites.