title: The local vascular tolerance to an intravenous infusion of a concentrated glutamine solution in ICU patients.
abstract: OBJECTIVE
  The beneficial effects of glutamine is well-documented in ICU patients. However, the documentation and control of enteral administration of glutamine is still insufficient. As an adjunct to enteral nutrition, a concentrated dipeptide solution may be given in a central venous line, but administration via a peripheral vein would be preferable. Therefore, we systematically evaluated local vascular tolerance following a concentrated dipeptide infusion in ICU-patients.
  
  
  METHODS
  ICU-patients (n=20) were randomized to receive a 20% alanyl-glutamine infusion of 0.5 g/kg or placebo during 4 h in a peripheral vein on 3 consecutive days. Local tolerance was evaluated clinically, by Maddox score, and ultrasonically before the infusion and on days 1, 4 and 8 after the infusion.
  
  
  RESULTS
  In the study, 56 out of 60 (93%) planned infusions were administered and 157 out of 168 (93%) clinical evaluations were successfully performed. The ultrasonic evaluation revealed that the utilized veins had a diameter of 2.15+/-0.8 mm (range, 1.0--4.4 mm). There were no signs of thrombophlebitis in any single vein.
  
  
  CONCLUSIONS
  Administration of a glutamine-containing dipeptide concentrate (20%) by peripheral veins is safe in terms of local tolerance, if a strict protocol is adapted for this purpose is used.
authors.affiliation: Department of Anesthesiology & Intensive Care, Huddinge University Hospital, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Berg
authors.forename: E
authors.initials: E
authors.lastname: Forsberg
authors.forename: J
authors.initials: J
authors.lastname: Wernerman
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D004151:Dipeptides / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010289:Parenteral Nutrition, Total / Q000379:methods*; D012996:Solutions; D014680:Veins / Q000187:drug effects
chemical_list: D004151:Dipeptides; D012996:Solutions; D005973:Glutamine; C054122:alanylglutamine