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Orotic aciduria and plasma urea cycle‐related amino acid alterations in short bowel syndrome, evoked by an arginine‐free diet
Author(s) -
Pita AM,
FernandezBustos A,
Rodes M,
Arranz JA,
Fisac C,
Virgili N,
Soler J,
Wakabayashi Y
Publication year - 2004
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607104028005315
Subject(s) - short bowel syndrome , orotic acid , arginine , medicine , urea cycle , glutamine , citrulline , endocrinology , ornithine , malabsorption , urea , uric acid , creatinine , chemistry , excretion , amino acid , biochemistry , parenteral nutrition
BACKGROUND: The small bowel is believed to play a crucial role in endogenous arginine synthesis. Therefore, an insufficient arginine supply in the situation of massive intestinal resection might impede normal arginine metabolism. This study sought to determine the clinical and metabolic effects of an arginine‐free diet in stable short‐bowel patients. METHODS: Four patients, mean age 49 years (range: 26–67), mean time from intestinal resection 46 m (range: 15–97), and remnant small bowel of 30 to 100 cm consumed an L‐amino acid arginine‐free diet (egg pattern) for 5 days (0.9 g protein equivalent/kg/d plus malabsorption adjustments). Fasting plasma amino acids, ammonium, and blood chemistries were assessed at days 0, 3, and 5. Urinary orotate, orotidine, uric acid, urea, creatinine, and total nitrogen were evaluated daily. RESULTS: Significant decreases in plasma levels of arginine, ornithine, and hydroxyproline occurred at day 5. A decreasing trend in plasma citrulline and a significant plasma glutamine increase were also observed in the same period. Conversely, ammonium concentrations remained normal. Regarding urine compounds, striking orotic aciduria with a peak at day 4 (14‐fold vs baseline) and significant decreases in uric acid and urea excretion were found. There were no relevant clinical events. CONCLUSIONS: Despite the limited number of patients in our work and their relative heterogeneity, our results support the idea of the indispensability of an exogenous arginine supply in humans under short bowel syndrome conditions. Studies in larger series are needed to further investigate these findings.