Glutamine in the intensive care unit

Cynober, Luc; Bandt, Jean‐Pascal De

doi:10.1097/mco.0000000000000014

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…Several studies have shown that a low glutamine concentration, associated with an unfavourable outcome, is valid for some 30% of ICU patients [4,5]. Comments on the REDOXS study interpretations vary widely – from ‘… should be abandoned in clinical practice’ [6] to ‘… should be reserved for specifically identified patients with compromised glutamine availability’ [7]. …”

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confidence: 99%

Glutamine – from conditionally essential to totally dispensable?

Wernerman

2014

Crit Care

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Recently a large multicentre randomised controlled trial in critically ill patients reported harm to the patients given supplementary glutamine. In the original publication, no explanation was offered for why this result was obtained; a large number of studies have reported beneficial effects or no effect, but never before reported harm. These results have been commented upon in a number of communications. Now some of the authors of the multicentre randomised controlled trial present a review and meta-analysis of glutamine supplementation, and the discrepancy of results is suggested to relate to intravenous administration to patients of supplementary glutamine via parenteral nutrition or a combination of enteral and parenteral nutrition in contrast to enteral administration of supplementation or a combination of enteral and parenteral supplementation. To explain results by epidemiological means only, by combining results into a meta-analysis, is perhaps not the best way to explain mechanisms behind results. Meta-analyses are primarily hypothesis generating. Launching treatment without a solid mechanistic explanation is always risky. Glutamine supplementation of the critically ill comes into that category. Now we will all have to do our homework and try to understand whether supplementation or omission of glutamine for patients fed parenterally is a good idea or not.

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confidence: 99%

Glutamine – from conditionally essential to totally dispensable?

Wernerman

2014

Crit Care

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“…Despite the strong physiologic evidence that critical illness increases the PR, most patients in modern ICUs are remarkably protein deprived 85 , 86 , 103 . One author even speculated that administering large doses of any single amino acid (eg, glutamine) could create distortions and toxicities in patients who are as severely protein deficient as most modern ICU patients 107 . Such a toxic effect seems unlikely, however, given the extremely low rates at which glutamine has been administered in clinical trials in comparison to its many‐fold‐greater endogenous turnover rate.…”

Section: Amino Acids As Supplements and Additivesmentioning

confidence: 99%

Human Protein and Amino Acid Requirements

Hoffer

2016

J Parenter Enteral Nutr

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Human protein and amino acid nutrition encompasses a wide, complex, frequently misunderstood, and often contentious area of clinical research and practice. This tutorial explains the basic biochemical and physiologic principles that underlie our current understanding of protein and amino acid nutrition. The following topics are discussed: (1) the identity, measurement, and essentiality of nutritional proteins; (2) the definition and determination of minimum requirements; (3) nutrition adaptation; (4) obligatory nitrogen excretion and the minimum protein requirement; (5) minimum versus optimum protein intakes; (6) metabolic responses to surfeit and deficient protein intakes; (7) body composition and protein requirements; (8) labile protein; (9) N balance; (10) the principles of protein and amino acid turnover, including an analysis of the controversial indicator amino acid oxidation technique; (11) general guidelines for evaluating protein turnover articles; (12) amino acid turnover versus clearance; (13) the protein content of hydrated amino acid solutions; (14) protein requirements in special situations, including protein-catabolic critical illness; (15) amino acid supplements and additives, including monosodium glutamate and glutamine; and (16) a perspective on the future of protein and amino acid nutrition research. In addition to providing practical information, this tutorial aims to demonstrate the importance of rigorous physiologic reasoning, stimulate intellectual curiosity, and encourage fresh ideas in this dynamic area of human nutrition. In general, references are provided only for topics that are not well covered in modern textbooks.

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“…For this reason glutamine has been postulated to be an essential amino acid in the critically ill and glutamine supplementation a beneficial intervention [1]. Furthermore, it has been hypothesized that most of the positive effect of glutamine supplementation is mediated by an increase in citrulline and arginine production [2].…”

Section: Introductionmentioning

confidence: 99%

Interrelationships between glutamine and citrulline metabolism

Marini

2016

Current Opinion in Clinical Nutrition and Metabolic Care

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Purpose of review To analyze the evidence that glutamine supplementation increases citrulline production. To determine the contribution of glutamine to the synthesis of citrulline. Recent findings Glutamine supplementation has been proposed in the treatment of critically ill patients; however, a recent large multicenter randomized controlled trial resulted in increased mortality in the glutamine supplemented group. Within this context, defining the contribution of glutamine to the production of citrulline, and thus to de novo arginine synthesis, has become a pressing issue. Summary The beneficial effects of glutamine supplementation may be partially mediated by the effects of glutamine on citrulline synthesis by the gut and the de novo synthesis of arginine by the kidney and other tissues. Although there is no strong evidence to support that glutamine is a major precursor for citrulline synthesis in humans, glutamine has the potential to increase overall gut function and in this way increase citrulline production.

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Glutamine in the intensive care unit

Abstract: Glutamine supplementation has been recognized as beneficial in acutely injured patients. However, recent conflicting results in either 'real-life conditions' or very severe situations suggest that its indications need to be more precisely determined.

Cited by 17 publications

References 23 publications

Glutamine – from conditionally essential to totally dispensable?

Glutamine – from conditionally essential to totally dispensable?

Human Protein and Amino Acid Requirements

Interrelationships between glutamine and citrulline metabolism

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