Yes

Diagnostic Agent, Pituitary Function

Pituitary function test (growth hormone); management of severe, uncompensated, metabolic alkalosis (pH greater than or equal to 7.55) after optimizing therapy with sodium and potassium supplements

C

Known hypersensitivity to arginine; renal or hepatic failure

1% to 10%:

Central nervous system: Headache

Gastrointestinal: Nausea, vomiting

Local: Venous irritation

Neuromuscular & skeletal: Numbness

Increased toxicity: Estrogen-progesterone combinations ( growth hormone response and glucagon and insulin effects); spironolactone (potentially fatal hyperkalemia has been reported)

Store at room temperature

Stimulates pituitary release of growth hormone and prolactin through origins in the hypothalamus; patients with impaired pituitary function have lower or no increase in plasma concentrations of growth hormone after administration of arginine. Arginine hydrochloride has been used for severe metabolic alkalosis due to its high chloride content.

Arginine hydrochloride has been used investigationally to treat metabolic alkalosis. Arginine contains 475 mEq of hydrogen ions and 475 mEq of chloride ions/L. Arginine is metabolized by the liver to produce hydrogen ions. It may be used in patients with relative hepatic insufficiency because arginine combines with ammonia in the body to produce urea.

Absorption: Oral: Well absorbed

Time to peak serum concentration: Within 2 hours

I.V.:

Children: 500 mg kg/dose administered over 30 minutes

Adults: 30 g (300 mL) administered over 30 minutes

Inborn errors of urea synthesis: Initial: 0.8 g/kg, then 0.2-0.8 g/kg/day as a continuous infusion

Metabolic alkalosis: Children and Adults: Arginine hydrochloride is a fourth-line treatment for uncompensated metabolic alkalosis after sodium chloride, potassium chloride, and ammonium chloride supplementation has been optimized.

Arginine dose (G) = weight (kg) x 0.1 x (HCO₃^- - 24) where HCO₃^- = the patient's serum bicarbonate concentration in mEq/L

Give 1/2 to 1/3 dose calculated then re-evaluate

Note: Arginine hydrochloride should never be used as an alternative to chloride supplementation but used in the patient who is unresponsive to sodium chloride or potassium chloride supplementation

Hypochloremia: Children and Adults: Arginine dose (mL) = 0.4 x weight (kg) x (103-Cl^-) where Cl^- = the patient's serum chloride concentration in mEq/L

Give 1/2 to 1/3 dose calculated then re-evaluate

May be infused without further dilution; maximum rate of I.V. infusion: 1 g/kg/hour (maximum: 60 g/hour)

None reported

None reported

No information available to require special precautions

No effects or complications reported

Patient should fast the evening prior to test; minimize stress/exercise before test since these may affect growth hormone production

I.V. infiltration of arginine may cause necrosis and phlebitis; may be infused without further dilution; maximum rate of I.V. infusion: 1 g/kg/hour (maximum: 60 g/hour)

Monitor acid-base status (arterial or capillary blood gases), serum electrolytes (sodium, potassium, chloride, HCO₃^--), BUN, glucose

Injection, as hydrochloride: 10% [100 mg/mL = 950 mOsm/L] (500 mL)

Bushinsky DA and Gennari FJ, "Life-Threatening Hyperkalemia Induced by Arginine," Ann Intern Med, 1978, 89(5 Pt 1):632-4.