Arginine supplementation should be used most cautiously in which patients?

• A. short bowel
• B. immunocompromised patients
• C. septic shock patients
• D. cirrhotic patients

Answer: (C)

Arginine is a substrate for nitric oxide production, and nitric oxide acts as a potent vasodilator. In septic shock, inducible nitric oxide synthase is driven up, leading to excessive nitric oxide and profound vasodilation with unstable blood pressure. Giving extra arginine in this setting can fuel even more NO production, worsening hypotension and tissue perfusion. That heightened risk makes septic shock patients the group in which arginine supplementation should be used most cautiously. In other conditions like short bowel, cirrhosis, or immunocompromised states, arginine may be considered with other clinical factors, but the acute hemodynamic risk from NO in septic shock is the strongest reason for caution.