RESTORATION OF NITROGEN HOMEOSTASIS IN A MAN WITH ORNITHINE TRANSCARBAMYLASE DEFICIENCY

被引:28
作者
BRUSILOW, SW
FINKELSTIEN, J
机构
[1] Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD
来源
METABOLISM-CLINICAL AND EXPERIMENTAL | 1993年 / 42卷 / 10期
关键词
D O I
10.1016/0026-0495(93)90135-B
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We evaluated the hypothesis that sodium phenylbutyrate-induced phenylacetylglutamine biosynthesis in a man with partial ornithine transcarbamylase (OTC) deficiency has a dual effect; it provides an additional vehicle for waste nitrogen excretion, and in the process it suppresses the patient's residual urea N synthesis, which then may be available for N homeostasis if the need arises. A 38-year-old man was studied over three periods. Period I was a control period during which he received a fixed caloric and N intake plus l-citrulline. Phenylbutyrate was added in period II and was maintained during period III, during which his N intake was increased. Plasma levels of ammonium and glutamine and net urea N synthesis were measured in each period; phenylacetylglutamine N synthesis was measured in periods II and III. These studies demonstrated that phenylbutyrate administration led to a 73% decrease in net de novo urea N synthesis during period II, which subsequently increased threefold in period III in response to the increased N intake. Phenylacetylglutamine N synthesis was 2.27 g/d, similar to his estimated maximum net urea N synthesis of 2.65 g/d. During periods II and III, his plasma levels of ammonium and glutamine improved as compared with period I when they were abnormally high. We conclude that sodium phenylbutyrate treatment of patients with urea cycle disorders who have significant residual enzyme activity results in both an improvement in waste N excretion and improved N homeostasis as a result of the generation of a reserve urea N synthetic capacity. This therapeutic approach may be useful in other nitrogen accumulation decreases, eg, portal-systemic encephalopathy. © 1993.
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页码:1336 / 1339
页数:4
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