Observations on Serial Plasma Citrulline Concentrations in a Patient with Intestinal Ischemia and Full-Thickness Necrosis After Severe Thermal Injury.

摘要

Recent critical car literature by Piton et al has demonstrated that plasma citrulline may be a helpful adjunct in determining prognosis as well as determining intestinal dysfunction and failure. Citrulline is an amino acid produced by mitochondria within small bowel enterocytes. Citrulline is not incorporated into any protein, its plasma concentration is entirely derived from enterocyte production, and it is metabolized by the kidneys to arginine. Decreased plasma citrulline levels correlate with loss of enterocyte mass in short bowel syndrome and are associated with poor outcomes in radiation enteritis, sepsis, and critical illness. We compared their findings with our own recent observations of serial plasma citrulline levels in a severely burned adult who ultimately died from nonocclusive mescenteric ischemia leading to full-thickness small bowel necrosis.