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Clinical Nutrition Week 2011: A Summary of Recommendations for Glutamine and Antioxidant Supplementation

Clinical Nutrition Week 2011: A Summary of Recommendations for Glutamine and Antioxidant Supplementation. Cecilia Freeman RD, LD, CNSC. Learning Objectives. Glutamine. Metabolic Functions of Glutamine. Immunologic Functions of Glutamine. Glutamine in Trauma. Enteral Glutamine Pros.

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Clinical Nutrition Week 2011: A Summary of Recommendations for Glutamine and Antioxidant Supplementation

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  1. Clinical Nutrition Week 2011: A Summary of Recommendations for Glutamine and Antioxidant Supplementation Cecilia Freeman RD, LD, CNSC

  2. Learning Objectives

  3. Glutamine

  4. Metabolic Functions of Glutamine

  5. Immunologic Functions of Glutamine

  6. Glutamine in Trauma

  7. Enteral Glutamine Pros

  8. Enteral Glutamine Cons

  9. Dosing Burn/Trauma Patients Medical/Surgical Intensive Care • 5-10 grams 4-5 x per day (0.4-0.5gm/kg/day) • Parenteral glutamine probably better • 0.35-0.5gm/kg/day • Greatest benefit ≥ 0.5g/kg/day IV

  10. General Recommendations

  11. Summary • 0.3-0.5g/kg/day, starting within first 24 hours, for at least 7 days • Improves clinical outcomes such as decreased episodes of pneumonia, bacteremia, and sepsis in trauma patients Houdijk et al, Lancet 1998

  12. Importance of Antioxidants

  13. Antioxidants

  14. Background • All SIRS patients had below normal selenium • Forceville X et Al, Crit Care Med 1998 • Selenium replacement may attenuate the progression to MOF, speed recovery • Bulgar E et al, Arch Surg 2001 • Ascorbic acid and α-tocopherol may reduce incidence of infections complications • Schorah C et al, Am J Clin Nutri 1996 • Antioxidant supplementation may prevent MOF • Bulgar E et al, Arch Surg 2001 • Bichard C et al, CCM 1990

  15. Supplementation in Critically Ill Surgery Patients

  16. Supplementation to facilitate ventilator weaning

  17. Selenium in sepsis

  18. Selenium in sepsis

  19. 2008 Premier Research Paper • Impact of High-Dose Antioxidants on Outcomes in Acutely Injured Patients • 28% relative risk reduction in mortality • Reduction in ICU and Hospital LOS • JPEN July/August 2008

  20. Summary • Antioxidant levels are low in critically ill and injured patients upon ICU admission and remain low • Supplementation is effective in raising levels • Supplementation reduced infectious complications and inflammatory response

  21. Take Home Information • Supplementation with these substances is proven to improve patient outcomes • As clinicians we should include glutamine and antioxidant supplementation recommendations along with our nutrition support (TF/TPN) recommendations for appropriate patients • Should we consider implementing protocols for glutamine and antioxidants in our facilities? • Would a combination of supplementation with glutamine and antioxidants together be beneficial?

  22. freemac@musc.edu Question

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