Glutamine to Icu Patients
Year: 2007
Type: dissertation
Abstract: Intravenous glutamine supplementation to intensive care patients using a\nglutamine containing dipeptide is now widely accepted in clinical\npractice. There are evidences that glutamine supplementation of ICU\npatients in need of parenteral nutrition improves mortality and\nmorbidity. The beneficial effects may be extended also to ICU patients on\ncombined enteral and parenteral nutrition and perhaps also to ICU\npatients on enteral nutrition only. The effect of intravenous and/or\nenteral glutamine supplementation to these patient groups is presently\nnot conclusive.\n\nTo facilitate clinical use of glutamine supplementation a number of\nsafety aspects are considered in this thesis work. The possibility to\nadminister the concentrated glutamine containing dipeptide solution in\nperipheral vessels, and the metabolic tolerance of the dipeptide\nformulation in ICU patients. Metabolic tolerance was assessed as the\nabsence of accumulation of the dipeptide, the absence of urinary losses\nof the dipeptide, and the clearance of dipeptide and constituent amino\nacids over time. Furthermore, the possible losses of the dipeptide and\nthe constituent amino acids during continuous renal replacement therapies\nin ICU patients with kidney failure have not been clarified. The extent\nof glutamine losses into the ultrafiltrate and the possibility that\nexogenous supplemented glutamine will be lost into the ultrafiltrate to a\nhigh degree have been addressed. Finally the concern that exogenous\nprovided glutamine may be converted into glutamate in the brain of head\ntrauma patients has been a concern. Head trauma patients some times\nsuffer from multiple organ failure and hence maybe treated with exogenous\nglutamine. The suggestion of a connection between elevated intracerebral\nglutamate levels and an unfavourable outcome in the head trauma patients\nhas been suggested. Therefore the possible connection between exogenous\nglutamine supplementations and the level of free glutamate interstitially\nin the brain and the balance of free glutamate and glutamine across the\nbrain was investigated.\n\nThe results show that a glutamine containing dipeptide in a concentrated\nsolution may be administered in the peripheral vein without any signs of\ninflammatory reaction. In addition, the glutamine containing dipeptide is\nmetabolically well tolerated in ICU patients. The losses of exogenously\nprovided glutamine into the ultrafiltrate during continuous renal\nreplacement therapy are not different from a situation where no exogenous\nsupply is given. The increased loss into the ultrafiltrate is on the\ncontrary an argument to increase the exogenous supplementation of\nglutamine. Finally, there was no connection between glutamine\nsupplementation and the level of free glutamate interstitially in the\nbrain and the balance of glutamate across the brain in head trauma\npatients.\n\nIn addition, posthoc analyses were performed demonstrating that the\nendogenous rate of appearance of glutamine (estimate of glutamine\nproduction) in ICU patients is of the same magnitude as in healthy\nindividuals. And it is suggested that this endogenous production is not\ninhibited by exogenous glutamine supplementation.\n\nThe results presented in this thesis work provide evidence that studies\nto elucidate outcome advantages for ICU patients in relation to\nintravenous glutamine supplementation are safe and can be encouraged.\nFurthermore new insights in glutamine production and handling of\nexogenous glutamine supplementation were gained.
Source: Figshare
Author: Agneta Berg
Language: French
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1913835034