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Arginine and nitric oxide metabolism in critically ill septic pediatric patients.
Crit Care Med. 2003 Feb; 31(2):591-7.CC

Abstract

OBJECTIVE

To investigate whole body, arginine metabolism and nitric oxide synthesis rates in septic, critically ill pediatric patients.

DESIGN

Prospective study.

SETTING

Pediatric intensive care unit at a general hospital.

PATIENTS

Ten consecutive septic patients age 6-16 yrs.

INTERVENTIONS

Septic patients received an 8-hr primed, constant intravenous tracer infusion of L-[guanidino-15N2]arginine, L-[1-13C]leucine, and [13C]urea. A 24-hr urine collection was obtained for determination of [15N]nitrate enrichment (15NO3(-)) and urinary nitrogen. The next day they received an infusion of L-[5-13C]arginine and L-[5-13C-ureido, 5,5, 2H2]citrulline. Blood samples were obtained for determination of plasma isotopic enrichment of the tracers given and of derived [15N]citrulline (nitric oxide synthesis), L-[13C-guanidino 5,5, 2H2]arginine (M+3 arg) (arginine synthesis), and [15N]urea (urea formation). Data are compared with historic controls from studies in healthy young adults.

MEASUREMENTS AND MAIN RESULTS

Plasma arginine fluxes were 67 +/- 21 and 72 +/- 17 micromol x kg(-1) x hr(-1), respectively, for the [15N2 guanidino] and the [13C] arginine labels, which were not different from reported adult values. The rates of arginine oxidation were 22.9 +/- 10.8 micromol x kg(-1) x hr(-1) and were higher than arginine synthesis rates of 9.6 +/- 4.2 micromol x kg(-1) x hr(-1) (p <.01); therefore, these patients were in a negative arginine balance. The rates of nitric oxide synthesis as estimated by the [15N]citrulline method were 1.58 +/- 0.69 micromol x kg(-1) x hr(-1) for septic patients and higher (p <.05) than values of 0.96 +/- 0.1 micromol x kg(-1) x hr(-1) in healthy adults. Septic patients were in a negative protein (leucine) balance of about -1.00 +/- 0.40 g x kg(-1) x day(-1).

CONCLUSIONS

Homeostasis of plasma arginine in septic patients was impaired compared with reported adult values. The rates of arginine oxidation were increased whereas net arginine synthesis was unchanged, leading to a negative arginine balance. The rates of nitric oxide synthesis and the fraction of plasma arginine used for nitric oxide and urea formation were increased. These findings suggest that under condition of sepsis, arginine becomes essential in critically ill children.

Authors+Show Affiliations

Pediatric Service, Massachusetts General Hospital, Boston, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12576971

Citation

Argaman, Zvi, et al. "Arginine and Nitric Oxide Metabolism in Critically Ill Septic Pediatric Patients." Critical Care Medicine, vol. 31, no. 2, 2003, pp. 591-7.
Argaman Z, Young VR, Noviski N, et al. Arginine and nitric oxide metabolism in critically ill septic pediatric patients. Crit Care Med. 2003;31(2):591-7.
Argaman, Z., Young, V. R., Noviski, N., Castillo-Rosas, L., Lu, X. M., Zurakowski, D., Cooper, M., Davison, C., Tharakan, J. F., Ajami, A., & Castillo, L. (2003). Arginine and nitric oxide metabolism in critically ill septic pediatric patients. Critical Care Medicine, 31(2), 591-7.
Argaman Z, et al. Arginine and Nitric Oxide Metabolism in Critically Ill Septic Pediatric Patients. Crit Care Med. 2003;31(2):591-7. PubMed PMID: 12576971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arginine and nitric oxide metabolism in critically ill septic pediatric patients. AU - Argaman,Zvi, AU - Young,Vernon R, AU - Noviski,Natan, AU - Castillo-Rosas,Luis, AU - Lu,Xiao-Ming, AU - Zurakowski,David, AU - Cooper,Mehrengise, AU - Davison,Caroline, AU - Tharakan,John F, AU - Ajami,Alfred, AU - Castillo,Leticia, PY - 2003/2/11/pubmed PY - 2003/3/26/medline PY - 2003/2/11/entrez SP - 591 EP - 7 JF - Critical care medicine JO - Crit. Care Med. VL - 31 IS - 2 N2 - OBJECTIVE: To investigate whole body, arginine metabolism and nitric oxide synthesis rates in septic, critically ill pediatric patients. DESIGN: Prospective study. SETTING: Pediatric intensive care unit at a general hospital. PATIENTS: Ten consecutive septic patients age 6-16 yrs. INTERVENTIONS: Septic patients received an 8-hr primed, constant intravenous tracer infusion of L-[guanidino-15N2]arginine, L-[1-13C]leucine, and [13C]urea. A 24-hr urine collection was obtained for determination of [15N]nitrate enrichment (15NO3(-)) and urinary nitrogen. The next day they received an infusion of L-[5-13C]arginine and L-[5-13C-ureido, 5,5, 2H2]citrulline. Blood samples were obtained for determination of plasma isotopic enrichment of the tracers given and of derived [15N]citrulline (nitric oxide synthesis), L-[13C-guanidino 5,5, 2H2]arginine (M+3 arg) (arginine synthesis), and [15N]urea (urea formation). Data are compared with historic controls from studies in healthy young adults. MEASUREMENTS AND MAIN RESULTS: Plasma arginine fluxes were 67 +/- 21 and 72 +/- 17 micromol x kg(-1) x hr(-1), respectively, for the [15N2 guanidino] and the [13C] arginine labels, which were not different from reported adult values. The rates of arginine oxidation were 22.9 +/- 10.8 micromol x kg(-1) x hr(-1) and were higher than arginine synthesis rates of 9.6 +/- 4.2 micromol x kg(-1) x hr(-1) (p <.01); therefore, these patients were in a negative arginine balance. The rates of nitric oxide synthesis as estimated by the [15N]citrulline method were 1.58 +/- 0.69 micromol x kg(-1) x hr(-1) for septic patients and higher (p <.05) than values of 0.96 +/- 0.1 micromol x kg(-1) x hr(-1) in healthy adults. Septic patients were in a negative protein (leucine) balance of about -1.00 +/- 0.40 g x kg(-1) x day(-1). CONCLUSIONS: Homeostasis of plasma arginine in septic patients was impaired compared with reported adult values. The rates of arginine oxidation were increased whereas net arginine synthesis was unchanged, leading to a negative arginine balance. The rates of nitric oxide synthesis and the fraction of plasma arginine used for nitric oxide and urea formation were increased. These findings suggest that under condition of sepsis, arginine becomes essential in critically ill children. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12576971/Arginine_and_nitric_oxide_metabolism_in_critically_ill_septic_pediatric_patients_ L2 - https://dx.doi.org/10.1097/01.CCM.0000050291.37714.74 DB - PRIME DP - Unbound Medicine ER -