None listed
Conditions
Brief summary
A low plasma concentration of glutamine at ICU admission is associated with an unfavorable outcome. A high glutamine concentration at ICU admission may also communicate a negative prediction. Exogenous glutamine supplementation normalizes plasma concentration and has been found to improve mortality outcome in the Scandinavian Glutamine Trial (Wernerman et al, Acta Anesth Scand 2011;55:812-18). However, the recent REDOX study showed a harmful effect of high doses of glutamine supplemented both parenteral and enteral (Heyland et al, NEJM 2013;368:1489-97). In an earlier study we have found that a small group of patients with high glutamine concentration at ICU admission had a higher 6-month mortality (Rodas Castillo et al, Clin Sci 2012;122:591-97). The group was too small to identify any other characteristics in the patients. However, acute liver failure was a diagnosis found within the subgroup. In another, still unpublished, study we have studied plasma glutamine concentration in patients with different kinds of hepatic insufficiency. The results show that both patients with acute fulminant liver failure and decompensated chronic liver failure have high glutamine concentrations. In order to be able to offer our ICU patients glutamine supplementation without risking an overdose by treating patients with normal plasma concentration, we have a machine (BioProfile Analyser from Nova Biochemical) which can analyze glutamine concentration in blood and plasma within minutes. We have previously studied endogenous glutamine production in ICU patients given intravenous glutamine supplementation (Mori et al, Crit Care. 2014 14;18(2)R72). With this study we intend to use the same method to study specific groups of ICU patients to elucidate if the abnormal plasma glutamine concentrations are related to alterations in endogenous production.
Interventions
To measure endogenous glutamine production in ICU patients by a previously verified bolus injection method (Mori et al. PLoS One 2014 8;9(5) e96601). Subjects will receive a bolus injection of both glutamine and phenylalanine labeled with a stable isotope (1-13C-glutamine 3 mg/kg; ring2H5-phenylalanine 0.3 mg/kg). Bolus will be given over 20 seconds followed by 60 blood samples over 90 min to get a decay curve. Initially 1 sample every 30 sec, then every 60 sec and finally every 3 min. Each blo
To measure endogenous glutamine production in ICU patients by a previously verified bolus injection method (Mori et al. PLoS One 2014 8;9(5) e96601). Subjects will receive a bolus injection of both glutamine and phenylalanine labeled with a stable isotope (1-13C-glutamine 3 mg/kg; ring2H5-phenylalanine 0.3 mg/kg). Bolus will be given over 20 seconds followed by 60 blood samples over 90 min to get a decay curve. Initially 1 sample every 30 sec, then every 60 sec and finally every 3 min. Each blood sample is 0,5 mL. During the measurement nutrition should be constant; to achieve this nutrition will not be altered two hours prior to the measurement or during the 90 minutes that blood samples are collected. Four different groups will be studied: 1. 20 patients with low plasma glutamine (<420 umol/L) at admission to the ICU. 2. 20 patients with high plasma glutamine (>900 umol/L) at admission to the ICU. 3. 20 patients staying >5 days in the ICU. 4. 20 patients with high plasma glutamine (>900 umol/L) at admission to the ICU and liver failure. Group 1 and 2 will be measured once in the first week of ICU stay. Group 3 will be measured several times with 3-5 days intervals. Group 4 will be measured several times with 2-3 days intervals. A subject may be included in more than one group.
Sponsors
Jan Wernerman
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Group 1: Plasma glutamine <420 umol/l at admission to the ICU. Group 2: Plasma glutamine >900 umol/l at admission to the ICU. Group 3: Expected length of stay in ICU >5 days. Group 4: Plasma glutamine >900umol/l at admissio to the ICu and liver failure.
Exclusion criteria
Absence of informed consent.
Outcome results
None listed