To the Editors:

The article by Stechmiller and colleagues titled “Arginine Immunonutrition in Critically Ill Patients: A Clinical Dilemma” (January 2004:17–23) contains many of the same errors as have prior analyses of the data. After reviewing the studies evincing dietary arginine immune stimulation in animals and humans, the reviewers raise the possibility that arginine might pose a risk to septic patients. This speculation is largely based on studies demonstrating increased lability of blood pressure in lipopolysaccharide-treated or septic animals after arginine loading. The reviewers then note that although infection rates and hospital length of stay decreased in the surgical patients fed an enteral immunonutritional formula with arginine compared with patients who were enterally fed a standard formula, no similar benefit was observed in multicenter studies of critically ill patients. Indeed, patients randomized to arginine enteral regimens had a higher...

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