Elsevier

The Journal of Nutrition

Volume 146, Issue 12, December 2016, Pages 2594S-2600S
The Journal of Nutrition

Parenteral or Enteral Arginine Supplementation Safety and Efficacy123

https://doi.org/10.3945/jn.115.228544Get rights and content
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Abstract

Arginine supplementation has the potential to improve the health of patients. Its use in hospitalized patients has been a controversial topic in the nutrition literature, especially concerning supplementation of septic patients. In this article, we review the relevant literature both for and against the use of arginine in critically ill, surgical, and hospitalized patients. The effect of critical illness on arginine metabolism is reviewed, as is its use in septic and critically ill patients. Although mounting evidence supports immunonutrition, there are only a few studies that suggest that this is safe in patients with severe sepsis. The use of arginine has been shown to benefit a variety of critically ill patients. It should be considered for inclusion in combinations of immunonutrients or commercial formulations for groups in whom its benefit has been reported consistently, such as those who have suffered trauma and those in acute surgical settings. The aims of this review are to discuss the role of arginine in health, the controversy surrounding arginine supplementation of septic patients, and the use of arginine in critically ill patients.

Keywords

arginine supplementation
critical care
surgery
immunonutrition
sepsis

Abbreviations

ADMA
asymmetric dimethylarginine
EN
enteral nutrition
eNOS
endothelial NO synthase
ICU
intensive care unit
iNOS
cytokine-inducible NO synthase
nNOS
neuronal NO synthase
PICS
persistent immunosuppressed inflammatory catabolic state
PN
parenteral nutrition

Cited by (0)

1

Published in a supplement to The Journal of Nutrition. The 9th Workshop on the Assessment of Adequate and Safe Intake of Dietary Amino Acids was presented at the "9th Amino Acid Assessment Workshop" held in Paris, France, 15–16 October 2015. The conference was sponsored by the International Council on Amino Acid Science (ICAAS). The Organizing Committee for the workshop included Sidney M Morris Jr., Dennis M Bier, Luc Cynober, Motoni Kadowaki, and Rajavel Elango. The Supplement Coordinator for this supplement was D’Ann Finley, University of California, Davis. Supplement Coordinator disclosures: D’Ann Finley received travel support and compensation from ICAAS for editorial services provided for this supplement publication. Publication costs for this supplement were defrayed in part by the payment of page charges. This publication must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, Editor, or Editorial Board of The Journal of Nutrition.

2

The authors reported no funding received for this study.

3

Author disclosures: MD Rosenthal, PW Carrott, J Patel, L Kiraly, and RG Martindale, no conflicts of interest.