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Clinical Nutrition Week 2011: A Summary of Recommendations for Glutamine and Antioxidant Supplementation. Cecilia Freeman RD, LD, CNSC. Learning Objectives. Glutamine. Metabolic Functions of Glutamine. Immunologic Functions of Glutamine. Glutamine in Trauma. Enteral Glutamine Pros.
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Clinical Nutrition Week 2011: A Summary of Recommendations for Glutamine and Antioxidant Supplementation Cecilia Freeman RD, LD, CNSC
Dosing Burn/Trauma Patients Medical/Surgical Intensive Care • 5-10 grams 4-5 x per day (0.4-0.5gm/kg/day) • Parenteral glutamine probably better • 0.35-0.5gm/kg/day • Greatest benefit ≥ 0.5g/kg/day IV
Summary • 0.3-0.5g/kg/day, starting within first 24 hours, for at least 7 days • Improves clinical outcomes such as decreased episodes of pneumonia, bacteremia, and sepsis in trauma patients Houdijk et al, Lancet 1998
Background • All SIRS patients had below normal selenium • Forceville X et Al, Crit Care Med 1998 • Selenium replacement may attenuate the progression to MOF, speed recovery • Bulgar E et al, Arch Surg 2001 • Ascorbic acid and α-tocopherol may reduce incidence of infections complications • Schorah C et al, Am J Clin Nutri 1996 • Antioxidant supplementation may prevent MOF • Bulgar E et al, Arch Surg 2001 • Bichard C et al, CCM 1990
2008 Premier Research Paper • Impact of High-Dose Antioxidants on Outcomes in Acutely Injured Patients • 28% relative risk reduction in mortality • Reduction in ICU and Hospital LOS • JPEN July/August 2008
Summary • Antioxidant levels are low in critically ill and injured patients upon ICU admission and remain low • Supplementation is effective in raising levels • Supplementation reduced infectious complications and inflammatory response
Take Home Information • Supplementation with these substances is proven to improve patient outcomes • As clinicians we should include glutamine and antioxidant supplementation recommendations along with our nutrition support (TF/TPN) recommendations for appropriate patients • Should we consider implementing protocols for glutamine and antioxidants in our facilities? • Would a combination of supplementation with glutamine and antioxidants together be beneficial?
freemac@musc.edu Question