This is Jeff Guy in surgery, ICU rounds.

Today we're going to have a journal review, and the topic is glutamine supplementation and

critical illness.

The article we're going to review is from the Journal of Burn Care at Rehab from 2006.

This is volume 27, pages 764 to 772.

The author is Mark Wendell.

We'll try to make the PDF of this article available on the website.

Glutamine is the most abundant amino acid found in plasma cells.

The primary site for synthesis and storage is skeletal muscle.

Glutamine is involved in gluconeogenesis, the acid base system, and synthesis of skeletal muscle. Glutamine is involved in glucanogenesis, the acid-based system, and synthesis of other amino

acids.

Glutamine is also a preferred oxidative fuel for rapidly dividing cells, such as lymphocytes,

hemucosal cells as the gastrointestinal tract.

Glutamine is considered a conditionally essential amino acid in metabolic stress, demand by the liver, kidney, and intestinal tract outstrips peripheral

production and release, and therefore plasma levels decrease rapidly.

Severe glutamine depletion occurs in major thermal injury.

If supplementation is not provided, adverse effects may include an increased risk of mortality

and infection, sustained inflammatory response, negative nitrogen balance, muscle wasting, and

reduced GI integrity.

After at least 20 years of research, glutamine supplementation is moving from the research

arena into clinical practice. Recommendations are now being suggested for Enneral Glutamine supplementation is moving from the research arena into clinical practice.

Recommendations are now being suggested for annal glutamine in burns and supplementation for all critical ill patients who require perenteral nutrition.

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