No abstract

In a paper by Ziegler et al (Ann Intern Med 116: 821-828, 1992), total parenteral nutrition supplemented with L-glutamine (TPN/GLN) was reported beneficial in patients receiving bone marrow transplantation (BMT) for hematologic malignancies. By using a similar protocol, we studied 29 patients with both hematologic malignancies and solid tumors, and with both allogeneic and autologous BMTs. In a double-blind, randomized approach, patients were given isocaloric, isonitrogenous TPN after BMT until they consumed 50% of their required diet orally. Total body water and extracellular water were measured before and after TPN in 10 patients. Total body water increased in patients receiving standard TPN and decreased significantly in patients receiving TPN/GLN. Length of hospital stay after BMT was significantly (5.8 days) less in patients receiving TPN/GLN. Incidence of positive bacterial cultures, clinical infections, and mortality did not differ significantly between the two groups. When the groups were subdivided into patients with hematologic malignancies and those with solid tumors, there were no significant differences in the above variables associated with TPN/GLN. In 17 of 30 additional hospitalized patients receiving standard TPN, substitution of TPN/GLN did not have discernible clinical or laboratory effects but appeared to be safe. Inclusion of patients with solid tumors and a higher mortality in our patients may have obscured beneficial effects of TPN/GLN observed by others.

Oral and parenteral GLN seemed to be of limited benefit for patients having AUTO or ALLO BMT for hematologic or solid malignancies. Further study of long-term effects of GLN in BMT seems warranted.

No abstract

It was the purpose of this study to measure and to compare the volumes of distribution of creatinine, urea and tritiated water in nephrectomized dogs. After bilateral nephrectomy a solution containing known amounts of these was infused intravenously and at a constant rate in some studies. Frequent arterial blood samples were taken during and following infusion for periods up to 20 hours and were analyzed for water and the infused substances. The respective volumes of distribution and rates of dilution were calculated. Isotopic water and urea were distributed in 95% and creatinine in 61% of their final volumes of distribution at the end of a 30-minute infusion. Final equilibrium occurred in about 90 minutes with water and urea and in about 4 hours with creatinine. Creatinine became distributed in 99 ± 3% of the tritiated water volume and in 101 ± 5% of the urea volume. Urea distributed in 98 ± 4% of the tritiated water volume. It is concluded that administered creatinine is distributed in total body water of nephrectomized dogs with an equilibrium time of about 4 hours and that urea is similarly distributed within 1 1/2 hours.