The amino acids citrulline, ornithine and arginine, total serum proteins, serum enzymes glutamic oxalacetic and glutamic pyruvic transaminases, blood ammonia and urea were measured in 20 marasmic children with manifest psychomotor changes, before and after nutritional rehabilitation, as well as in 10 healthy age-matched children. Serum protein levels were significantly low and plasma ammonia concentrations were significantly elevated in marasmic children before refeeding (177 +/- 66 micrograms/dl). Plasma ammonia concentrations decreased significantly after 4 weeks of nutritional rehabilitation (38 +/- 18 micrograms/dl). The levels of blood urea, serum enzymes, citrulline arginine, and ornithine did not differ among the study groups. These findings denote that hyperammonemia in marasmic children is neither due to defective hepatic function nor due to enzymatic blockade in the urea cycle.

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