Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: Glutamine supplementation | Wernerman Annals of Intensive Care 2011 1 25 http content 1 1 25 Ù Annals of Intensive Care a SpringerOpen Journal REVIEW Open Access Glutamine supplementation Jan Wernerman Abstract Intravenous glutamine supplementation is standard care when parenteral nutrition is given for critical illness. There are data of a reduced mortality when glutamine supplementation is given. In addition standard commercial products for parenteral nutrition do not contain any glutamine due to glutamine instability in aqueous solutions. For the majority of critical ill patients who are fed enterally the available evidence is insufficient to recommend glutamine supplementation. Standard formulation of enteral nutrition contains some glutamine 2-4 g L. However this dose is insufficient to normalize glutamine plasma concentration. Plasma concentration of glutamine is low in many patients with critical illness and a low level is an independent risk factor for mortality. A low plasma glutamine concentration is the best indicator of glutamine depletion. Data are emerging about how the endogenous production of glutamine is regulated. We know that skeletal muscle is the major producer of glutamine and that a part of the profound depletion of skeletal muscle seen in critical illness is a reflection of the need to produce glutamine. Glutamine is utilized in rapidly dividing cells in the splanchnic area. Quantitatively most glutamine is oxidized but the availability of glutamine in surplus is important for the de novo synthesis of nucleotides and necessary for cell division and protein synthesis. More knowledge about the regulation of the endogenous production of glutamine is needed to outline better guidelines for glutamine supplementation in the future. Recommendation Presently the recommendation from ESPEN and ASPEN SCCM is to add intravenous IV glutamine supplementation when total parenteral nutrition TPN is given to critically ill patients 1-3 . In all guidelines
