title: Serum citrulline levels correlate with enteral tolerance and bowel length in infants with short bowel syndrome.
abstract: OBJECTIVE
  To determine if serum levels of CIT (a nonprotein amino acid synthesized by the intestine) correlate with total parenteral nutrition (PN)-independence in children with short bowel syndrome (SBS).
  
  
  METHODS
  We prospectively obtained serum amino acid profiles over a 24-month interval from all infants with SBS 3 weeks to 4 years of age. Remaining small intestine length was recorded at surgery, and percent enteral calories tolerated (enteral calories divided by enteral plus parenteral calories x 100) was determined in 24 infants with SBS and 21 age-matched controls (blood drawn for non-gastrointestinal symptoms).
  
  
  RESULTS
  Mean CIT for controls was 31 +/- 2 micromol/L. In patients with SBS (n = 24), serum CIT correlated linearly with percent enteral calories (R = 0.85; P <.001) and with bowel length (R = 0.47; P < or =.03). CIT level in patients with SBS weaned off PN was 30 +/- 2 micromol/L; in those subsequently weaned off PN, 20 +/- 2 micromol/L; and in those who would remain PN-dependent, 11 +/- 2 micromol/L ( P < or =.01). Serum CIT > or =19 micromol/L had 94% sensitivity and 67% specificity for being off or coming off total PN.
  
  
  CONCLUSIONS
  Serum CIT level >19 micromol/L in children with SBS is associated with development of enteral tolerance and may be a useful predictive test.
authors.affiliation: Department of Pediatrics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. mrhoads@ochsner.org
authors.forename: J Marc
authors.initials: JM
authors.lastname: Rhoads
authors.forename: Emily
authors.initials: E
authors.lastname: Plunkett
authors.forename: Joseph
authors.initials: J
authors.lastname: Galanko
authors.forename: Steven
authors.initials: S
authors.lastname: Lichtman
authors.forename: Lesli
authors.initials: L
authors.lastname: Taylor
authors.forename: Angela
authors.initials: A
authors.lastname: Maynor
authors.forename: Timothy
authors.initials: T
authors.lastname: Weiner
authors.forename: Katherine
authors.initials: K
authors.lastname: Freeman
authors.forename: J Lindhe
authors.initials: JL
authors.lastname: Guarisco
authors.forename: Guo Yao
authors.initials: GY
authors.lastname: Wu
mesh_terms: D002675:Child, Preschool; D002956:Citrulline / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000033:anatomy & histology; D010289:Parenteral Nutrition, Total; D011379:Prognosis; D011446:Prospective Studies; D012778:Short Bowel Syndrome / Q000097:blood*
chemical_list: D002956:Citrulline