Our aim is to compare the effects of Arginine and Citrulline supplementation on the prognosis of critically ill patinents in intensive care unit receiving enteral nutrition,A total of 105 critically traumatic patients admitted to the intensive care units and receive entral nutritional support will be recruited and randomly allocated into three groups. patients are head trauma patients graid 2,3.Two groups will be intervened each by citrulline or arginine (10 gam/day for 10 days) and the third group will revived just enteral nutritional support without immune supplements.
pateints are between 20 -70 years old, with BMI:18.5-30, and eligible of enteral nutrition support.Septic, Hemodynamically and metabolically unstable patients, and more than 3 days NPO will be excluded from the study.This clinical trial will be executed in 5 trauma ICUs at a trauma center in teaching hospital of Kamyab in Mashhad, Three groups will be compared for clinical severity (evaluaes with APACHI II score), length of hospital stay and complications, inflammatory state (CRP,IL6) nutritional markers (RBP, Pre-Albumine), lipide profile (LDL-C, HDL-C, Cholestrol, Triglycirid), plasma glucose, electrolytes, liver enzymes levels(AST, ALT, ALP, LDH total), NO production, PAB( Pro-oxidant and Anti oxidant Balance), urea and creatinine. Serum levels of Arginine, Citrulline, Ornithine, Glutamine and lysine.