title: When Is It Appropriate to Use Arginine in Critical Illness?
abstract: In health, arginine is considered a nonessential amino acid but can become an essential amino acid (ie, conditionally essential amino acid) during periods of metabolic or traumatic stress as endogenous arginine supply is inadequate to meet physiologic demands. Arginine depletion in critical illness is associated with impairments in microcirculatory blood flow, impaired wound healing, and T-cell dysfunction. The purpose of this review is to (1) describe arginine metabolism and role in health and critical illness, (2) describe the relationship between arginine and asymmetric dimethylarginine, and (3) review studies of supplemental arginine in critically ill patients.
authors.affiliation: Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA jpatel2@mcw.edu.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: Department of Surgery, Division of Trauma Surgery, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Rosenthal
authors.affiliation: Department of Surgery, University of Florida, Gainesville, Florida, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Rosenthal
mesh_terms: D001120:Arginine / Q000031:analogs & derivatives / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D019587:Dietary Supplements; D006801:Humans
chemical_list: C018524:N,N-dimethylarginine; D001120:Arginine
keywords: arginase; arginine; asymmetric dimethylarginine; critical illness; nitric oxide; sepsis; surgery; trauma; wound healing