title: The effects of intravenous, enteral and combined administration of glutamine on malnutrition in sepsis: a randomized clinical trial.
abstract: Our aim was to compare the effects of intravenous, enteral, and enteral plus intravenous supplemented glutamine on plasma transferrin, nitrogen balance, and creatinine/height index in septic patients with malnutrition. Blood and urine samples were collected for transferrin, urea and creatinine measurements. Samples, SOFA score and protein-calorie intake values were repeated on days 7 and 15. Patients (n:120) were randomly divided into 4 groups. Group I received 30 g/day IV glutamine, group II received 30 g/day enteral glutamine, group III received 15 g/day IV and 15 g/day enteral glutamine. Group IV received only enteral feeding as a control group. Transferrin levels decreased in group IV (p<0.01 0-7 days, p<0.01 7-15 days, p<0.01 0-15 days). Nitrogen balance levels were highest in group IV when compared with group I (p<0.05, p<0.001), group II (p<0.001), and group III (p<0.05, p<0.001) on days 7-15. Creatinine/height indexes increased in group I (p<0.001), group II (p<0.001), group III (p<0.001), and group IV (p<0.05) on day 15. In group III the creatinine/height index was higher than in groups I and II (p<0.05). In group IV, creatinine/height index was lower than in group I (p<0.01) and group II (p<0.001). Protein-calorie intake in group IV was higher than others on day 7 (p<0.05). SOFA scores of group IV were higher than the other groups on day 15 (p<0.05). This study demonstrated, that combined route of gln supplementation resulted in the most positive outcome to transferrin, creatine/height index and nitrogen balance (on days 7 and 15) during the catabolic phase of septic patients with malnutrition.
authors.affiliation: Istanbul University Cerrahpasa Medical Faculty, Department of Anesthesiology and Reanimation, Kocamustafapasa, Istanbul, Turkey. ytunali@yahoo.com.
authors.forename: Guniz Meyancı
authors.initials: GM
authors.lastname: Koksal
authors.forename: Emre
authors.initials: E
authors.lastname: Erbabacan
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tunali
authors.forename: Gulsah
authors.initials: G
authors.lastname: Karaoren
authors.forename: Suphi
authors.initials: S
authors.lastname: Vehid
authors.forename: Huseyin
authors.initials: H
authors.lastname: Oz
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood / Q000652:urine; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D008875:Middle Aged; D009584:Nitrogen / Q000008:administration & dosage / Q000652:urine; D010288:Parenteral Nutrition; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000652:urine; D014168:Transferrin / Q000032:analysis; D014508:Urea / Q000097:blood / Q000652:urine
chemical_list: D004044:Dietary Proteins; D014168:Transferrin; D005973:Glutamine; D014508:Urea; D003404:Creatinine; D009584:Nitrogen