Clinical Use

DEFICIENCY: PREVENTION AND TREATMENT

During periods of increased need, L-GIn is considered conditionally essential. Glutamine depletion can result in increased intestinal permeability, microbial translo- L-Glutamine 613

cation across the gut barrier, impaired wound healing, sepsis and multiple organ

failure (Miller 1999). Experimental studies have proposed a number of benefits for patients with conditions that increase glutamine requirements. The suggested mechanisms include effects on pro-inflammatory cytokine expression, gut integrity, enhanced ability to mount a stress response and improved immune cell function, and studies have shown potential benefit with regard to mortality, length of hospital stay, and infection.

To date the results of studies using glutamine dipeptides in TPN have proven to be very promising in treating patients for whom enteral feeding is impossible. Benefits from studies of enteral glutamine supplementation have tended to be less pronounced but preliminary trials have demonstrated benefits in some conditions, especially at high doses (e.g. 30 g/day enterally) (Wischmeyer 2003).

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