Longitudinal pattern of glutamine/glutamate balance across the leg in long-stay intensive care unit patients.
OBJECTIVE
Progressive muscle wasting is a characteristic feature of patients treated at the intensive care unit (ICU). As a consequence, endogenous glutamine production by skeletal muscle may be compromised. We investigated the time pattern of the glutamine and glutamate net balance across the leg in long-stay ICU patients.


METHODS
Critically ill patients with multiple organ failure that were expected to stay in the ICU for more than 3 days were included in a longitudinal study. Possible changes in amino acid net balance over the leg muscle were investigated overtime. The patients (n=20) were studied descriptively every third or fourth day, on a total of 2-7 occasions.


RESULTS
The glutamine net release from leg muscles did not change significantly during the initial 2 weeks of ICU stay and was not related to the plasma concentration of glutamine. The net uptake of glutamate across the leg muscles was unaltered during this time period, but it was found to correlate statistically with both the arterial glutamate concentration and the glutamine net release. A continuous net release of phenylalanine indicated a progressive net loss of muscle protein in these patients.


CONCLUSIONS
The net release of glutamine from skeletal muscle does not decrease in stabilized critically ill patients with multiple organ failure over the initial 2 weeks of ICU stay, despite progressive muscle wasting.
Vesali
R F
RF
Department of Anesthesiology & Intensive Care and Clinical Research Center at Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden.
Klaude
M
M
Rooyackers
O E
OE
TJäder
I
I
Barle
H
H
Wernerman
J
J
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000596:Amino Acids / Q000032:analysis / Q000378:metabolism; D016638:Critical Illness; D005260:Female; D018698:Glutamic Acid / Q000032:analysis / Q000378:metabolism*; D005973:Glutamine / Q000032:analysis / Q000378:metabolism*; D006801:Humans; D007362:Intensive Care Units; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000378:metabolism*; D018482:Muscle, Skeletal / Q000378:metabolism*; D010649:Phenylalanine / Q000378:metabolism
D000596:Amino Acids; D005973:Glutamine; D018698:Glutamic Acid; D010649:Phenylalanine