Plasma urea-cycle-related amino acids, ammonium levels, and urinary orotic acid excretion in short-bowel patients managed with an oral diet.
OBJECTIVE
The small intestine contains several enzymes involved in arginine synthesis and converts glutamine to citrulline, the major compound for endogenous arginine synthesis. This study was conducted to assess the plasma status of urea-cycle intermediates and orotic urinary excretion in short-bowel patients.


METHODS
Thirteen stable short-bowel syndrome patients (7 men; 60.2+/-15.2 years) were studied. Patients were divided into moderately resected (Group A; n=6) and severely resected (Group B; n=7) according to their remnant bowel length (Group A: 61-150 cm; Group B: < or =60 cm). All subjects were consuming an oral diet plus dietetic supplements. Plasma urea-cycle amino acids, ammonium and urinary orotic acid were determined.


RESULTS
Plasma glutamine levels were significantly higher in both patient groups than in the control group (P<0.001). Regarding citrulline, Group B levels were significantly lower vs. controls (P<0.001). Comparisons between patient groups showed higher arginine in Group A (P<0.05) and non-statistically lower citrulline in Group B. Blood ammonium and orotic urinary excretion were normal.


CONCLUSIONS
Although plasma citrulline and glutamine alterations were found, patients showed no hyperammonemia or orotic aciduria, which suggests a certain degree of adaptation in arginine and related amino acid metabolism, when an adequate dietary supply of arginine is provided.
Pita
A M
AM
Department of Endocrinology and Nutrition, Hospital de Bellvitge, Calle Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Spain.
Wakabayashi
Y
Y
Fernandez-Bustos
M A
MA
Virgili
N
N
Riudor
E
E
Soler
J
J
Farriol
M
M
D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009963:Orotic Acid / Q000652:urine*; D000644:Quaternary Ammonium Compounds / Q000097:blood*; D012778:Short Bowel Syndrome / Q000178:diet therapy* / Q000378:metabolism*; D014508:Urea / Q000097:blood*
D000596:Amino Acids; D000644:Quaternary Ammonium Compounds; D009963:Orotic Acid; D014508:Urea