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L-Glutamine for Acute Pancreatitis.

Forty-four patients (mean age, 43 years) with severe acute pancreatitis (two-thirds of cases due to biliary disease, 23% due to alcohol) were randomly assigned to receive, beginning after hospital admission, standard parenteral nutrition (control group) or an isonitrogenous, isocaloric parenteral nutrition formula that supplied L-glutamine in the form of L-alanyl-L-glutamine (0.4 g per kg of body weight per day). The number of patients who developed infections was significantly lower in the L-glutamine group than in the control group (41% vs. 73%; p = 0.03). The mortality rate was nonsignificantly lower in the L-glutamine group than in the control group (9% vs. 23%; p = 0.20). Nitrogen balance, serum albumin, and certain measures of immune function were significantly better in the L-glutamine group than in the control group.

Comment: While glutamine is considered a nonessential amino acid, additional amounts are needed under conditions of extreme stress, in order to support gastrointestinal and immune function. The results of the present study indicate that the addition of L-glutamine to parenteral nutrition decreased the number of infections and possibly decreased mortality, when compared with standard parenteral nutrition, in patients with severe acute pancreatitis. L-glutamine has been reported to produce similar benefits in other critically ill patients. For parenteral nutrition, L-glutamine is frequently given in the form of L-alanyl-L-glutamine, because of its greater stability.

Fuentes-Orozco C et al. L-Alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis. |PEN| Parenter Enteral Nutr. 2008;32:403-411.

by Alan R. Gaby, MD
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Publication:Townsend Letter
Article Type:Brief article
Geographic Code:1USA
Date:Jun 1, 2009
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