Arginine metabolism in a small animal model of sepsis and after hemihepatectomy

Abstract

Introduction: Asymmetric dimethylarginine (ADMA) is an inhibitor of the arginine-NO pathway. ADMA accumulates when degradation in the liver by dimethylarginine dimethylaminohydrolase is impaired. In theory, plasma citrulline, formed when arginine is converted by NO synthase, and when ADMA is metabolized, would be lowered and ornithine, formed by the degradation of arginine in the urea cycle, would be potentially elevated when ADMA accumulates as in sepsis and in liver failure [1]. Methods: Fourteen male Wistar rats were randomly allocated to lipopolysaccharide (LPS) or hemihepatectomy (HH). Plasma levels of arginine, ADMA, citrulline and ornithine were measured before and 120 minutes after 5 mg/kg LPS and HH, respectively. Results: See Table 1. Conclusions: Plasma levels of arginine and derivatives should not be interpreted as a reflection of metabolism at the tissue level. In HH, the elevated ADMA levels suggest dimethylarginine dimethylaminohydrolase activity depends on the liver tissue mass. S56 P134 Ginger extract dietary supplementation effects on delayed gastric emptying and ventilator-associated pneumonia in adult respiratory distress syndrome patients M Mokhtari, Z Shariatpanahi SBU Medical Sciences, Tehran, Iran Critical Care 2009, 13(Suppl 1):P134 (-doi 10.1186/cc7298) Introduction: Delayed gastric emptying is one of the major reasons for enteral feeding intolerance in ICU patients [1-3]. We studied the effect of ginger supplementation to the diet on development of ventilator-associated pneumonia (VAP) and adult respiratory distress syndrome (ARDS) in ICU patients [2]. Methods: In a prospective, randomized, placebo-controlled fashion, 32 ARDS mechanically ventilated patients who were fed entrally were studied. Patients were randomized into two groups; one group had ginger added and the other had placebo added to their enteral feeding. The amount of feeding tolerated in the first 48 hours, the amount of feeding tolerated during the entire study period, development of VAP, the number of ICU-free days, the number of ventilator-free days and morality were evaluated. Results: Enteral feeding tolerated in the first 48 hours of study was significantly higher in patients with the ginger-supplemented diet (51% vs. 57%, P <0.005). However this was not different during the entire study period (92% vs. 93%, P = 0.42). VAP was seen in 6.3% of the patients in the ginger group and in 31.3% of the control group, which was not statistically significant (P = 0.08). The ICU mortality of 15.6% was similar in the two groups. The median number of ventilator-free days of 10 versus 7 days and ICU-free days of 7 versus 4 days were significantly higher in the ginger extract group, with respective P values of 0.02 and 0.04. Conclusions: Supplementing the diet with ginger extract in ARDS patients reduces the delayed gastric emptying risk and helps reduce the duration of mechanical ventilation and increases ICUfree days.