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  • Poster presentation
  • Open Access

Inflammation causes arginine to become an essential amino acid in critically ill children

  • 1,
  • 2,
  • 1 and
  • 3
Critical Care201115 (Suppl 1) :P384

  • Published:


  • Arginine
  • Stable Isotope
  • Essential Amino Acid
  • Citrulline
  • Bronchiolitis


In critically ill children we previously found decreased plasma levels of arginine (Arg) and its precursor citrulline (Cit), with a strong inverse relation to C-reactive protein (CRP) [1]. Cit is the sole precursor of Arg de novo synthesis in the body. We hypothesized that Arg becomes an essential amino acid, because Cit availability is reduced during inflammation. Therefore we studied Cit and Arg production, using stable isotope technology, in relation to the severity of inflammation in critically ill children.


Twenty-two critically ill children (age 0.89 ± 0.04 years) with different levels of inflammation were studied on day 3 post-admission; viral bronchiolitis (group 1, n = 9), infectious disease without shock (group 2, n = 6) and septic shock (group 3, n = 7). A 2-hour stable isotope tracer protocol was performed after at least 4 hours fasting to determine Arg and Cit kinetics. Data presented as mean ± SE. Statistics by ANOVA, Spearman's correlation.


See Figure 1 for results per group. CRP was significantly different between groups. Cit production was significantly lower in the group with highest inflammation compared with the group with lowest inflammation. Cit production was inversely correlated with plasma CRP (r = -0.58, P < 0.001).
Figure 1
Figure 1

CRP, Cit and Arg production. CRP, P < 0.01 between all groups (a, b, c); d, P < 0.05.


Our data show that with increasing rate of inflammation the production of Arg's precursor Cit is severely depressed. Previously we found that de novo Arg production is almost equal to Cit production [2]. As a consequence, Arg availability becomes fully dependent on tissue protein breakdown and nutrition. Inflammation causes Arg to become an essential amino acid in critically ill children.

Authors’ Affiliations

Erasmus MC, Rotterdam, the Netherlands
MUMC, Maastricht, the Netherlands
UAMS, Little Rock, AR, USA


  1. Van Waardenburg , et al.: Am J Clin Nutr. 2007, 86: 1438-1444.PubMedGoogle Scholar
  2. Luiking , et al.: Am J Clin Nutr. 2009, 89: 142-152.View ArticlePubMedGoogle Scholar


© De Betue et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.