Newsletter

[ Vol. 13 No. 3 ] (September - December 2012 )
The role and levels of glutamine in critically ill patients

Tsann-Long Hwang
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University (Taiwan) 

Glutamine is one of the most important amino acids that provide this function. It acts as the preferred respiratory fuel for lymphocytes, hepatocytes and intestinal mucosal cells and is metabolized in the gut to citrulline, ammonium and other amino acids. After severe stress, several amino acids are mobilized from muscle tissue to supply energy and substrate to the host. Low concentrations of glutamine in plasma reflect reduced stores in muscle and this reduced availability of glutamine in the catabolic state seems to correlate with increased morbidity and mortality. Adding glutamine to the nutrition of clinical patients, enterally or parenterally, may reduce morbidity. Several excellent clinical trials have been performed to prove efficacy and feasibility of the use of glutamine supplementation in parenteral and enteral nutrition. The increased intake of glutamine has resulted in lower septic morbidity in certain critically ill patient populations.

Glutamine-containing parenteral or enteral nutrition has not been widely adopted in patients after surgery. There have been few good-quality randomized controlled trials with adequate statistical power to evaluate glutamine use in these patients groups. In critical illness there is dramatic over-amplification of the inflammatory response, probably together with cellular immune dysfunction, whereas after surgery patients experience much less cytokine activation and some suppression of cell-mediated immunity, which increases the risk of infection.

We have prospectively investigated the glutamine levels and effects of glutamine supplements for patients with high APACHE II (≥12) and high SSS (≥15) in Surgical and Trauma ICU. The patients with high APACHE II or ISS in surgical ICU will be checked their glutamine levels, and those less than 0.42 mmol/L will be randomized into groups A and B. Those patents with glutamine level higher than 0.42 mmol/L will be also given with normal saline for 5 days as control group C. Our results showed the patients with glutamine levels lower than 0.42 mmoles/L had significantly higher mortality and ICU stay. Among them, the patients underwent 5 days of parental or enteral glutamine supply could reduce their mortality and ICU stay.

From  
The 14^th Congress of Parenteral and Enteral Nutrition Society of Asia
“From Nutrition Support to Nutrition Therapy”
October 14-16, 2011, Taipei, Taiwan 
Page: 23