question about the use of glutamine in patient with severe malnutrion, poor wound healing but impending hepatic and renal failure?

[Wei Erh Cheng]

Dear Dr Heyland:

 

Glad to join this nutrition group. I am an pulmonologist and intensivist in Taiwan. Recently, one difficult weaning patient was transferred from SICU to my respiratory care center. Due to recurred wound leakage after surgery for PPU, she has haven TPN support for nearly one month. Howevere, her nutrition status is terrible bad accompanied with recurrent septicemia, poor wound healing and impaired hepatic/renal function. Should I use glutamine in this patient? should I monitor the serum glutamine level? What kind side effects or complications would happen? Your help would be highly appreciated. Looking forward to hearing from you ASAP.

 

Wei Erh Cheng. M.D.

Taichung, Taiwan

[Daren Heyland]

HI

I would definitely recommend IV glutamine associated with her PN useage. It is very difficult to measure glutamine levels and I am not aware of anyone measuring these as a part of clinical practice, nor do I think it is necessary. Glutamine is safe, not to worry about complications. If kidney function is impaired (and patient not on dialysis), with high doses, you may see some rise in urea levels but these are not thought to be clinically important.

Hope that is helpful

Cheers

Daren Heyland

 

Ps. I will be in Taiwan in 2 weeks at PENSA! May be see you there!

 

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