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EFFECTS OF GLUTAMINE ON INFECTIOUS COMPLICATIONS AND MORTALITY IN CRITICAL ILLNESS

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). However, in the largest study of a heterogeneous group of 363 Australian ICU patients receiving enteral nutrition supplemented with either glutamine or glycine (Hall et al. 2003), glutamine supplementation had no effect on 6-month mortality or incidence of severe sepsis. When data from 8 trials examining the effect of glutamine-supplemented enteral nutrition in critically ill patients were pooled in a meta-analysis, there was no overall difference in mortality (RR = 0.81, 95% confidence interval 0.48-1.34) or infectious complications (RR = 0.83, 95% confidence interval 0.64-1.08) between groups who received glutamine and those who did not (Composition of Enteral Nutrition: Glutamine 2013). As a result, there is insufficient evidence to recommend routine use of enteral glutamine in critically ill patients (Composition of Enteral Nutrition: Glutamine 2013).

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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)
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)
Immunomodulatory Effects of Glutamine
While glutamine’s role in limiting oxidative injury remains unclear, its anti-inflammatory effects are well established and dependent on levels of heat shock proteins (HSP), acute phase reactants that assist in the refolding of proteins denatured by incipient insults (Wischmeyer et al. 2001a). Three...
(Glutamine : biochemistry, physiology, and clinical applications)
CELL PROLIFERATION, THE WARBURG EFFECT, AND GLUTAMINE METABOLISM
The central role of glutamine in cellular proliferation was established in the 1950s by Harry Eagle, who showed that glutamine is required at concentrations above all other amino acids to sustain the growth and proliferation of cultured cells (Eagle et al. 1956); indeed, every scientist who does cell...
(Glutamine : biochemistry, physiology, and clinical applications)
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...
(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)