Glutamine dipeptide supplemented TPN maintains intestinal function in critically ill

Tremel, H.; Kienle, Beate; Weilemann, L. S.; Abele, R.; Fichtl, B.; Stehle, Peter; Fürst, Peter

doi:10.1016/0261-5614(92)90156-k

Cited by 9 publications

(4 citation statements)

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“…In this case, glutamine, tyrosine, and cysteine can be added as intravenous dipeptides, as their single forms are unstable in water [33,34]. The addition of these amino acids has been shown to improve nitrogen balance, promote muscle protein synthesis, and avoid TPN-related intestinal atrophy [35,36].…”

Section: Nitrogenmentioning

confidence: 99%

Postoperative Total Parenteral Nutrition

1999

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Surgical trauma induces complex physiologic changes that lead to catabolism and loss of body cell mass. This reaction is usually mild but can be exacerbated by previous malnutrition and postoperative complications. To avoid severe metabolic distress, nutritional therapy may be prescribed, using the enteral route whenever possible. Postoperative total parenteral nutrition (TPN) is indicated for patients already receiving TPN preoperatively, those severely malnourished prior to major surgery, those unable to eat satisfactorily for 7 days, or patients presenting with severe complications. Postoperative TPN should last for at least 7 days. The total energy requirements are between 30 and 35 kcal/kg/day. About 50% to 70% should be provided in the form of carbohydrates, and 20% to 30% in the form of lipids. The optimal input rates for glucose and lipids are 4 to 5 g/kg/day and 80 mg/kg/hr, respectively. The ideal nitrogen administration is 250 to 300 mg/kg/day, and the optimal calorie/nitrogen ratio is 150 to 200. Some specific amino acids can be added as intravenous dipeptides. An adequate follow-up must include clinical and biochemical parameters. Several trials evaluated the impact of TPN in postoperative patients, but further well designed, controlled clinical trials are still necessary to address a great number of unanswered questions.

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Section: Nitrogenmentioning

confidence: 99%

Postoperative Total Parenteral Nutrition

1999

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“…Safety is perhaps even more important when the nutrient is provided in pharmacologic doses, or to patients who are not deficient in that nutrient. Results from most short-term studies indicate no safety concerns with intravenously infused glutamine in normal volunteers (N=14) [53,55,66,69,72,89]. However, Hornsby-Lewis et al [51] found that glutamine-supplemented TPN in home TPN patients was associated with significantly elevated hepatic aminotransferases after 4 weeks, and for this reason they were forced to cease their study.…”

Section: Safety Issuesmentioning

confidence: 93%

“…Tremel et al [55] studied 12 patients in an intensive care unit. Six patients received glutamine-supplemented TPN, whereas the other six received standard TPN, each for 9 days.…”

Section: Intestinal Morphology and Function During Tpn And Lack Of Enmentioning

confidence: 99%

Glutamine for the gut: Mystical properties or an ordinary amino acid?

Buchman

1999

Curr Gastroenterol Rep

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Glutamine is a nonessential amino acid that can be synthesized from glutamate and glutamic acid by glutamine synthetase. It is the preferred fuel for the small intestine in the rat. Results from animal studies suggest that both glutamine-supplemented parenteral nutrition and enteral diets may prevent bacterial translocation. This effect may be modulated through the preservation and augmentation of small bowel villus morphology, intestinal permeability, and intestinal immune function. The existing data from studies with humans are less compelling. What, if any, intestinal deficits actually occur during provision of exclusive parenteral nutrition remains unclear. Furthermore, the clinical significance of these changes is largely undefined. Nevertheless, glutamine and glutamine supplementation appear to be important for the normal maintenance of intestinal morphology and function, intestinal adaptation following resection, and prevention of clinical infection related to bacterial translocation. The existing data on the use of parenteral and enteral glutamine for preservation of intestinal morphology and function and prevention of bacterial translocation in humans are reviewed in this article. Pertinent animal data are also described.

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“…Stehle et al zeigten, daû die Stickstoffbilanz unter einer mit Alanylglutamin angereicherten totalparenteralen Erna Èhrung nach gro È ûeren chirurgischen Eingriffen deutlich besser war als bei isonitrogenen und isokalorischen Vergleichslo È sungen. Die Studien von van der Hulst et al [9] und Tremel et al [10] wiesen nach, daû parenterale Lo È sungen, angereichert mit Glycilglutamindipeptid, bei Patienten zu einer gro È ûeren Ho È he der intestinalen Villi und zu einer geringeren Du È nndarmpermeabilita Èt fu È hrten. Tremel …”

Section: Glutaminunclassified

Bedeutung von Supplementen nach Operationen

Thul¹

2000

Visc Med

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A number of supplements were included in the nutritional regimen to improve the postoperative outcome after extended abdominal surgical procedures. In the enteral nutrition glutamine, arginine, nucleotides and omega-3 fatty acids achieved a more important role. Stable dipeptides that are metabolisable to glutamine are available for parenteral nutrition. Many clinical studies have shown better nitrogen balances, lower bacterial colonisation of the bowel, improved nutrient uptake and shorter hospital stay. The immunological system is positively influenced by application of omega-3 fatty acids. In critically ill patients, low levels of antioxidants like vitamins E, C and beta-carotene are detectable. These substances are gaining increasing importance as supplements.

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Glutamine dipeptide supplemented TPN maintains intestinal function in critically ill

Cited by 9 publications

References 0 publications

Postoperative Total Parenteral Nutrition

Postoperative Total Parenteral Nutrition

Glutamine for the gut: Mystical properties or an ordinary amino acid?

Bedeutung von Supplementen nach Operationen

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