Intravenous glutamine administration after major burn injury: Nutrition or pharmacology?

The use of intravenous nutrition or total parenteral nutrition (TPN) has been shown to increase infectious morbidity in severely burned patients. Based on this, the use of intravenous nutrition following burn injury has right-fully fallen out of favour. However, recent data indicate that glutamine, given intravenously in pharmacological doses, in addition to routine enteral or parenteral nutrition, may decrease infectious morbidity and improve outcomes following burn injury and other states of critical illness. Thus, glutamine may function as a 'drug' rather than a nutrient in the face of critical illness and injury. Further, it is possible that glutamine may be able to reverse some of the negative effects of TPN, making it a safer and more viable option in patients unable to be fed enterally. It is plausible that intravenous administration of 'pharmaconutrients' such as glutamine, may act as pharmacological interventions, rather then solely as nutritional supplements.

Duke Scholars

Author Paul Edmund Wischmeyer Anesthesiology, Critical Care Medicine