Intravenous glutamine supplementation to head trauma patients leaves cerebral glutamate concentration unaffected

• Published in: Intensive care medicine Vol. 32; no. 11; pp. 1741 - 1746
• Main Authors: BERG, A, BELLANDER, B. M, WANECEK, M, GAMRIN, L, ELVING, Ase, ROOYACKERS, O, UNGERSTEDT, U, WERNERMAN, J
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.11.2006; Berlin Springer Nature B.V
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Brain - metabolism; Care and treatment; Catheters; Clinical death. Palliative care. Organ gift and preservation; Coma; Contusions; Craniocerebral Trauma - therapy; Cross-Over Studies; Dosage and administration; Drugs; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine; Epidural; Female; Glutamic Acid - blood; Glutamine; Glutamine - blood; Glutamine - therapeutic use; Head injuries; Hemorrhage; Humans; Intensive care; Intensive care medicine; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Nutrition; Parenteral Nutrition; Patients; Plasma; Trauma; Traumatic brain injury; Ventilators; Sweden; Human; Nervous system diseases; Intensive care; Intravenous administration; Craniocerebral; Central nervous system; Glutamate; Encephalon; Excitatory aminoacid; Neurotransmitter; Supplementation; Head trauma; Resuscitation; Glutamine
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-006-0375-3

There 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. The 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. Patients with severe head trauma (GCS<or=8; n=15) on routine monitoring, including intracerebral microdialysis, were randomly assigned to treatment followed by placebo or placebo followed by treatment. Glutamine infusion increased plasma glutamine concentration by 30%, but not plasma glutamate concentration. Intracerebral glutamate was unaffected in median values and in all individual patients. Intravenous 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.