Altering the amino acid profile in total parenteral nutrition solutions can be of benefit in certain conditions. Which of the following conditions are associated with a benefit by supplementation with the amino acid type listed?

a. Acute renal failure and essential amino acids

c. Short gut syndrome and glutamine

In a number of conditions, altering the amino acid profile of the total parenteral nutrition solution can be of benefit. TPN with amino acids of high biologic value may decrease the mortality in patients with acute renal failure. These solutions, containing high quality amino acids, can improve nitrogen balance and diminish urea nitrogen. Provision of essential amino acids only allows the body to maximally utilize nitrogen for the synthesis of non-essential amino acids and thereby helps prevent rapid rises in blood urea nitrogen. There appears to be no advantages to using essential amino acids if the patient is already being dialyzed every other day and therefore a balanced standard amino acid solution is recommended. Because of liver damage and portasystemic shunting, patients with hepatic failure develop derangements in circulating levels of amino acids. The plasma aromatic/branch chain amino acid ratio is increased favoring the transport of aromatic amino acids across the blood brain barrier. These amino acids are precursors of false transmitters which contribute to lethargy and encephalopathy. Treatment of individuals with liver failure with solutions enriched in branch chain amino acids and deficient in aromatic amino acids results in improved tolerance to administration of protein and clinical improvement in encephalopathic states. Glutamine-enriched TPN partially attenuates villous atrophy and may be useful in treatment of short gut syndrome.