• A Berg, B M Bellander, M Wanecek, L Gamrin, Ase Elving, O Rooyackers, U Ungerstedt, and J Wernerman.
• Karolinska University Hospital, Huddinge, Sweden.
• Intensive Care Med. 2006 Nov 1; 32 (11): 1741-6.

ObjectiveThere is reluctance to use glutamine-containing i.v. nutrition for neurosurgical patients, as this may result in elevated intracerebral glutamate levels, which are thought to be associated with neuronal injury and cell swelling, causing an increase in ICP and an unfavourable outcome. As general ICU patients benefit from i.v. glutamine supplementation in terms of reduced mortality and morbidity, neurosurgical patients might also be candidates for such treatment, if the possible relation between i.v. glutamine supplementation and a possible increase in cerebral glutamate could be sorted out.Design And SettingThe study protocol had a crossover design with a 24h treatment period and a 24h placebo period in random order. Treatment was a glutamine containing dipeptide, L-alanyl-L-glutamine 200mg/ml, for 20h; placebo was saline. The rate of infusion was 0.125ml/kg/h, which is equal to 0.34g/kg of glutamine over the 20h period. Microdialysate was collected for analysis in 120min portions. The flow through the microdialysis catheter was 0.3microl/min.SubjectsPatients with severe head trauma (GCSMeasurements And ResultsGlutamine infusion increased plasma glutamine concentration by 30%, but not plasma glutamate concentration. Intracerebral glutamate was unaffected in median values and in all individual patients.ConclusionIntravenous glutamine in clinically relevant doses leaves cerebral glutamate unaffected. This opens the possibility of evaluating the effects of i.[Symbol: see text]v. glutamine supplementation upon outcome for neurosurgical ICU patients.

17 keywords...

hide…