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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).

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Enteral Glutamine Supplementation
There are few high-quality trials investigating the clinical benefit of enteral glutamine supplementation. In one small study, burn patients receiving enteral glutamine supplementation had a significant decrease in mortality compared with patients who did not receive supplementation (Garrel et al. 2003)....
(Glutamine : biochemistry, physiology, and clinical applications)
METABOLIC STATES ASSOCIATED WITH POSITIVE EFFECTS OF GLUTAMINE SUPPLEMENTATION
In certain states associated with insulin resistance, an apparent increased tissue requirement for glutamine occurs, often resulting in low levels of plasma glutamine (Borel et al. 1998). These include Type 2 Diabetes Mellitus (T2DM) (Samocha-Bonet et al. 2011), severe exercise (Iwashita et al. 2005),...
(Glutamine : biochemistry, physiology, and clinical applications)
GLUTAMINE SUPPLEMENTATION STUDIES
In a study of healthy young males, Iwashita et al. observed that increases in energy expenditure, and both carbohydrate and fat oxidation after glutamine supplementation with a meal may be related to the effect of glutamine on insulin action and glucose disposal (Borel et al. 1998; Iwashita et al. 2006)....
(Glutamine : biochemistry, physiology, and clinical applications)
Rationale for and Efficacy of Glutamine Supplementation in Critical Illness
Christina C. Kao and Farook Jahoor CONTENTS 14.1 Metabolic and Physiologic Roles of Glutamine Relevant to Critical Illness........................195 14.1.1 Glutamine Synthesis and Carbon Metabolism.........................................................196 14.1.2 Glutamine and Glucose Metabolism........................................................................196...
(Glutamine : biochemistry, physiology, and clinical applications)
Parenteral Glutamine Supplementation
Glutamine supplementation can be provided via either oral or intravenous administration. Conventional parenteral nutrition formulas do not contain glutamine, because glutamine is not stable in aqueous solution. At room temperature, there is significant hydrolysis of glutamine to glutamic acid and ammonia....
(Glutamine : biochemistry, physiology, and clinical applications)
PHYSIOLOGIC EFFECTS OF GLUTAMINE SUPPLEMENTATION IN HUMANS
Glutamine Supplementation and Glucose Metabolism The potential clinical benefits of glutamine are derived from glutamine’s physiologic and metabolic roles as shown in Table 14.2. Because critical illness is associated with increased glucose production, hyperglycemia, and insulin resistance and...
(Glutamine : biochemistry, physiology, and clinical applications)
Glutamine Supplementation and Glucose Metabolism
The potential clinical benefits of glutamine are derived from glutamine’s physiologic and metabolic roles as shown in Table 14.2. Because critical illness is associated with increased glucose production, hyperglycemia, and insulin resistance and glutamine is an important precursor for glucose production,...
(Glutamine : biochemistry, physiology, and clinical applications)
Glutamine Supplementation and Gut Function
Because glutamine is the major energy source for enterocytes, glutamine may be necessary to maintain gut barrier function, restrict translocation of bacteria, and consequently help to prevent the development of multisystem organ failure. In postsurgical patients receiving TPN, addition of Ala-Gln prevented...
(Glutamine : biochemistry, physiology, and clinical applications)
Glutamine Supplementation and Heat Shock Proteins
The induction of HSPs is a key mechanism, which provides cellular protection against systemic inflammation and renders cells more resistant to extreme stress. Because glutamine upregulates the expression of HSP-70 in animal models (Wischmeyer et al. 2001), its effect on HSP in critically ill patients...
(Glutamine : biochemistry, physiology, and clinical applications)