Omithine (Om; a-ketoglutarate (aKG) salt) and arginine (Arg) supplementation of enteral diets has been advocated in the treatment of hypercatabolism of trauma patients, but both compounds are subject to extensive hepatic metabolism. To compare the metabolism of these two compounds and to evaluate the possible influence of the aKG moiety, livers were perfused with aKG, Om, ornithine a-ketoglutarate (OKG) or Arg (n 6 in each group) for 1 h. Arg uptake was nearly fourfold higher than Om uptake (690 (SD 162) v. 178 (SD 30) nmol/min per g liver), and Om uptake was not modified by aKG. Om was totally metabolized by the liver, whereas Arg led to Om release (408 (SD 159) nmol/min per g liver) and a threefold stimulation of urea production (Arg 1-44 (SD 0%) Y. Om 0.45 (SD 0.09) pmol/min per g liver). aKC alone only increased hepatic aspartate uptake but, when essociated with Om as OKG, it led to an increase in glutamate release and in proline content in the liver and to a decrease in proline uptake. From these findings we conclude that (1) Arg load is extensively metabolized by the liver, inducing urea production, (2) in enteral use, Om supplementation appears preferable to Arg as it is less ureogenic (as also recently demonstrated in viva in stressed rats receiving isomolar amounts of Arg and Om), (3) the liver participates in the OrwlKG metabolic interaction, mostly in proline metabolism, which occurs in the splanchnic area.Arginine: a-Ketoglutarate: Liver: Ornithine Nutritional support has emerged as an important component of the treatment of severely ill patients, but there is a need for qualitative improvements through the use of compounds which can modulate protein turnover. In this respect, ornithine (Om), as its a-ketoglutarate (aKG) salt, and arginine (Arg) are promising candidates and several studies have provided firm evidence that supplementation of enteral or parenteral nutrition with ornithine