Abstract
How to cite this article: Todi S. Glutamine Supplementation: The Pendulum Keeps on Swinging. Indian J Crit Care Med 2019;23(8):350-351.
Highlights
Glutamine level in the serum like many other metabolic, hormonal and vitamin molecules become deficient during stress (e.g vitamin C, vitamin D, selenium, vasopressin, cortisol) and severity of the deficieny of these molecules are consistently associated with poor outcome
Heterogeneity of nutrition trials make meaningful conclusion difficult, leading to variability in practice patterns. This heterogeneity results from (i) case mix of the trial population, as beneficial effects are found in trauma,burn,cancer surgery and pancreatitis patient and not in medically ill and septic patient treated with glutamine (ii) variable route of administration, enteral, parenteral or both
Contrary to the concept of personalised medicine, these interventions are applied irrespective of the baseline serum levels in patients e.g in REDOX study, glutamine levels were measured in a selected group of study population and only one third of them were found to be glutamine deficient, one third to have a normal level and one third having a high level of glutamine at baseline and adding further glutamine to these patients may have resulted in harmful effects
Summary
Immunonutrition has always been a hot topic of pro/con debate in critical care community. Replacement of these deficient molecules, on the other hand, have not been shown to improve hard outcome markers like mortality in general intensive care population.[3] This may be due to the fact that the association of deficiency with poor outcome, usually reflect an epiphenomenon and does not represent causality.
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