ABSTRACT
BACKGROUND: Nutritional depletion has been related to low glutamine levels in plasma and gut mucosa. This study was set up to investigate the effects of glutamine-enriched total parenteral nutrition on intestinal morphology and permeability. METHODS: Twenty-three depleted patients were randomized and after stabilization baseline measurements were performed. Plasma glutamine concentrations, gut morphology (including proliferation and lymphocyte markers) and intestinal permeability were measured. After administration during 8-10 days of a glutamine enriched total parenteral nutrition or an isonitrogenous control solution the measurements were repeated. RESULTS: No significant changes in glutamine concentrations, intestinal permeability, mucosal morphology or gut mucosal inflammation were observed between groups. CONCLUSIONS: Glutamine enriched total parenteral nutrition in a depleted patient population does not result in improvements in gut morphology and gut barrier function.
Subject(s)
Glutamine/administration & dosage , Intestinal Mucosa/drug effects , Malnutrition/therapy , Parenteral Nutrition , Permeability/drug effects , Adult , Aged , Female , Glutamine/blood , Humans , Immunohistochemistry , Intestinal Mucosa/metabolism , Intestinal Mucosa/pathology , Male , Middle Aged , Preoperative Care , Treatment OutcomeABSTRACT
BACKGROUND & AIMS: Most stable-isotope methods to evaluate whole body protein metabolism in patients are invasive and difficult to use in children. In this study protein metabolism was evaluated with the non-invasive [15N]glycine single oral dose method in critically ill children and the value of the method is discussed. METHODS: [15N]glycine (100mg) was given orally to children (mean age 5.5 years; range 0.6-15.5 years) with meningococcal septic shock (MSS, n = 8), pneumonia (n = 5), and to healthy, fed and post-absorptive children (n = 10). Urine was collected during 9h, total amount of NH(3), labelled NH(3) and nitrogen were measured, and protein turnover, synthesis and breakdown were calculated using urinary NH(3) as end-product. RESULTS: Mean protein turnover in children with MSS, pneumonia and fed and post-absorptive healthy children was 0.63+/-0.13, 0.38+/-0.10, 0.28+/-0.03 and 0.28+/-0.02g N/kg/9h, respectively. Mean protein synthesis was 0.55+/-0.12, 0.29+/-0.09, 0.18+/-0.02, 0.20+/-0.02g N/kg/9h, respectively. Mean protein breakdown was 0.56+/-0.14, 0.28+/-0.12, 0.08+/-0.03, 0.28+/-0.02g N/kg/9h, respectively. Protein turnover, synthesis and breakdown were significantly increased in MSS patients compared to fed healthy children (P <0.01) and post-absorptive children (P <0.05). Protein turnover, protein synthesis, protein breakdown were significantly correlated with disease severity and body temperature (P <0.05). CONCLUSION: Results of whole body protein metabolism measured with the [15N]glycine single oral dose method in children with MSS and in healthy children were in line with expectations based on results obtained in earlier reports and with different methods.
Subject(s)
Critical Illness , Glycine , Proteins/metabolism , Child , Child, Preschool , Female , Glycine/administration & dosage , Humans , Infant , Male , Meningococcal Infections/metabolism , Nitrogen Isotopes/administration & dosage , Pneumonia, Bacterial/metabolism , Shock, Septic/metabolism , Shock, Septic/microbiologyABSTRACT
alpha-Glutathione S-transferase (alpha-GST) is a biochemical parameter used to estimate the amount of proximal tubule damage to a kidney. In normal clinical practice, the concentration of alpha-GST in urine is determined by a rather time-consuming immunochemical test, the enzyme-linked immunosorbent assay (ELISA). Kidneys from non-heart-beating (NHB) donors are perfused prior to transplantation. The determination of alpha-GST concentration in the perfusate to monitor damage is also done by means of an ELISA test. However, because this is a time-consuming method, it would be helpful to find a parameter proportional to GST concentrations that would be available within minutes. We therefore compared the method of determining alpha-GST concentration via ELISA with that of determining the enzymatic activity of GST, which is much faster (results available within 10 min). The comparison was made using 150 preserved kidneys that had been perfused for 6 h. The correlation was found to be very good, as indicated by the linear regression data: r=0.954, P<0.001. pi-Glutathione S-transferase (pi-GST) was also determined by means of an ELISA test, and the concentration of pi-GST was compared with the enzymatic activity of the "total" GST. The precision of the enzymatic method, given by intra- and interassay variation, was 1.5% and 10.5%, respectively.
