Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis
Glutamine supplementation in specific groups of critically ill patients results in favourable clinical outcome. Enhancement of citrulline and arginine synthesis by glutamine could serve as a potential mechanism. However, while receiving optimal enteral nutrition, uptake and enteral metabolism of glu...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Hindawi Limited
2016-01-01
|
Series: | Journal of Nutrition and Metabolism |
Online Access: | http://dx.doi.org/10.1155/2016/1373060 |
id |
doaj-75ce1207210c401f89aed5a5898bc9b1 |
---|---|
record_format |
Article |
spelling |
doaj-75ce1207210c401f89aed5a5898bc9b12020-11-24T22:16:24ZengHindawi LimitedJournal of Nutrition and Metabolism2090-07242090-07322016-01-01201610.1155/2016/13730601373060Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine SynthesisMechteld A. R. Vermeulen0Saskia J. H. Brinkmann1Nikki Buijs2Albertus Beishuizen3Pierre M. Bet4Alexander P. J. Houdijk5Johannes B. van Goudoever6Paul A. M. van Leeuwen7Department of Internal Medicine, VU University Medical Center, 1081 HV Amsterdam, NetherlandsDepartment of Surgery, VU University Medical Center, 1081 HV Amsterdam, NetherlandsDepartment of Surgery, VU University Medical Center, 1081 HV Amsterdam, NetherlandsDepartment of Intensive Care Unit, VU University Medical Center, 1081 HV Amsterdam, NetherlandsDepartment of Clinical Pharmacology and Pharmacy, VU University Medical Center, 1081 HV Amsterdam, NetherlandsDepartment of Surgery, Medical Center Alkmaar and Trial Center Holland Health, Alkmaar, NetherlandsDepartment of Pediatrics, VU University Medical Center, 1081 HV Amsterdam, NetherlandsDepartment of Surgery, VU University Medical Center, 1081 HV Amsterdam, NetherlandsGlutamine supplementation in specific groups of critically ill patients results in favourable clinical outcome. Enhancement of citrulline and arginine synthesis by glutamine could serve as a potential mechanism. However, while receiving optimal enteral nutrition, uptake and enteral metabolism of glutamine in critically ill patients remain unknown. Therefore we investigated the effect of a therapeutically relevant dose of L-glutamine on synthesis of L-citrulline and subsequent L-arginine in this group. Ten versus ten critically ill patients receiving full enteral nutrition, or isocaloric isonitrogenous enteral nutrition including 0.5 g/kg L-alanyl-L-glutamine, were studied using stable isotopes. A cross-over design using intravenous and enteral tracers enabled splanchnic extraction (SE) calculations. Endogenous rate of appearance and SE of glutamine citrulline and arginine was not different (SE controls versus alanyl-glutamine: glutamine 48 and 48%, citrulline 33 versus 45%, and arginine 45 versus 42%). Turnover from glutamine to citrulline and arginine was not higher in glutamine-administered patients. In critically ill nonseptic patients receiving adequate nutrition and a relevant dose of glutamine there was no extra citrulline or arginine synthesis and glutamine SE was not increased. This suggests that for arginine synthesis enhancement there is no need for an additional dose of glutamine when this population is adequately fed. This trial is registered with NTR2285.http://dx.doi.org/10.1155/2016/1373060 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mechteld A. R. Vermeulen Saskia J. H. Brinkmann Nikki Buijs Albertus Beishuizen Pierre M. Bet Alexander P. J. Houdijk Johannes B. van Goudoever Paul A. M. van Leeuwen |
spellingShingle |
Mechteld A. R. Vermeulen Saskia J. H. Brinkmann Nikki Buijs Albertus Beishuizen Pierre M. Bet Alexander P. J. Houdijk Johannes B. van Goudoever Paul A. M. van Leeuwen Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis Journal of Nutrition and Metabolism |
author_facet |
Mechteld A. R. Vermeulen Saskia J. H. Brinkmann Nikki Buijs Albertus Beishuizen Pierre M. Bet Alexander P. J. Houdijk Johannes B. van Goudoever Paul A. M. van Leeuwen |
author_sort |
Mechteld A. R. Vermeulen |
title |
Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis |
title_short |
Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis |
title_full |
Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis |
title_fullStr |
Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis |
title_full_unstemmed |
Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis |
title_sort |
enteral glutamine administration in critically ill nonseptic patients does not trigger arginine synthesis |
publisher |
Hindawi Limited |
series |
Journal of Nutrition and Metabolism |
issn |
2090-0724 2090-0732 |
publishDate |
2016-01-01 |
description |
Glutamine supplementation in specific groups of critically ill patients results in favourable clinical outcome. Enhancement of citrulline and arginine synthesis by glutamine could serve as a potential mechanism. However, while receiving optimal enteral nutrition, uptake and enteral metabolism of glutamine in critically ill patients remain unknown. Therefore we investigated the effect of a therapeutically relevant dose of L-glutamine on synthesis of L-citrulline and subsequent L-arginine in this group. Ten versus ten critically ill patients receiving full enteral nutrition, or isocaloric isonitrogenous enteral nutrition including 0.5 g/kg L-alanyl-L-glutamine, were studied using stable isotopes. A cross-over design using intravenous and enteral tracers enabled splanchnic extraction (SE) calculations. Endogenous rate of appearance and SE of glutamine citrulline and arginine was not different (SE controls versus alanyl-glutamine: glutamine 48 and 48%, citrulline 33 versus 45%, and arginine 45 versus 42%). Turnover from glutamine to citrulline and arginine was not higher in glutamine-administered patients. In critically ill nonseptic patients receiving adequate nutrition and a relevant dose of glutamine there was no extra citrulline or arginine synthesis and glutamine SE was not increased. This suggests that for arginine synthesis enhancement there is no need for an additional dose of glutamine when this population is adequately fed. This trial is registered with NTR2285. |
url |
http://dx.doi.org/10.1155/2016/1373060 |
work_keys_str_mv |
AT mechteldarvermeulen enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis AT saskiajhbrinkmann enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis AT nikkibuijs enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis AT albertusbeishuizen enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis AT pierrembet enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis AT alexanderpjhoudijk enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis AT johannesbvangoudoever enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis AT paulamvanleeuwen enteralglutamineadministrationincriticallyillnonsepticpatientsdoesnottriggerargininesynthesis |
_version_ |
1725789930780622848 |