Enteral Glutamine Supplementation

Standard enteral formulas also contain little glutamine. When glutamine is given as part of commercially available immuno-modulating formulas, the glutamine concentration is variable, ranging from 5 g/L to 13.4 g/L (Marik and Zaloga 2008). The pharmacokinetics of enterally administered glutamine are not as clear as those of parenterally administered glutamine. The majority of enterally administered glutamine is absorbed by the upper jejunum (Dechelotte et al. 1991) and thus may not reach the distal intestines. In healthy humans, 40%-75% of dietary glutamine undergoes first-pass splanchnic extraction, and this is also true in critically ill, fasting adults (Kao et al. 2013). Nevertheless, administration of enteral glutamine does significantly increase plasma glutamine concentration in a dose-dependent manner (Dechelotte et al. 1991) and improves plasma glutamine concentrations in critically ill patients (Zhou et al. 2003). However, it does not alter muscle glutamine concentration or muscle glutamine kinetics in critical illness (Gore and Wolfe 2002). Although both parenteral and enteral glutamine administration lead to significant increases in plasma glutamine concentration, there is a greater increase in glutamine concentration via the parenteral route (Melis et al. 2005).

< Prev   CONTENTS   Source   Next >