Serum citrulline levels correlate with enteral tolerance and bowel length in infants with short bowel syndrome.
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.
Rhoads
J Marc
JM
Department of Pediatrics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. mrhoads@ochsner.org
Plunkett
Emily
E
Galanko
Joseph
J
Lichtman
Steven
S
Taylor
Lesli
L
Maynor
Angela
A
Weiner
Timothy
T
Freeman
Katherine
K
Guarisco
J Lindhe
JL
Wu
Guo Yao
GY
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*
D002956:Citrulline