Kinetics of plasma arginine and leucine in pediatric burn patients

The dynamic status of whole-body arginine and leucine was investigated in eight severely burned (mean 55% of body surface area) pediatric patients (mean age 5.3 y) at a mean of 16 d after their initial injury. Plasma amino acid kinetics were estimated by using primed constant intravenous infusions of L-[13C-guanidino]arginine and L-[I-13C]leucine given for 4 h. Each patient was studied twice within 2 d. The patients were studied either in a "basal" state, which involved removal of amino acids from the total parenteral nutrition (TPN) solution for 8 h before the tracer study, or while receiving complete TPN. Nitrogen intake was 0.58 +/- 0.08 g.kg-1.d-1 with nonprotein energy intake equivalent to 197 +/- 29 kJ.kg-1.d-1. Plasma leucine and arginine fluxes (mumol.kg-1.h-1) were 208 +/- 35 and 108 +/- 18 for basal and 290 +/- 38 and 195 +/- 22 for TPN periods, respectively. Leucine oxidation was 42 +/- 7 and 59 +/- 9 mumol.kg-1.h-1 for basal and TPN periods, respectively, indicating a higher rate of leucine loss in the absence of a leucine intake than that expected for healthy individuals. The arginine kinetic data implied little net de novo arginine synthesis and further suggested increased rates of arginine degradation from burn injury. The expected rate of urea excretion, based on the basal rate of leucine oxidation, agreed closely with the measured output of urinary urea. These findings suggest that arginine is a conditionally indispensable amino acid for maintaining body protein homeostasis and nutrition in severely burned pediatric patients. The metabolic response of these children appears to be quantitatively similar to that for severely burned adult patients.