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Journal of Nutrition and Metabolism
Volume 2016 (2016), Article ID 1373060, 13 pages
Clinical Study

Enteral Glutamine Administration in Critically Ill Nonseptic Patients Does Not Trigger Arginine Synthesis

1Department of Internal Medicine, VU University Medical Center, 1081 HV Amsterdam, Netherlands
2Department of Surgery, VU University Medical Center, 1081 HV Amsterdam, Netherlands
3Department of Intensive Care Unit, VU University Medical Center, 1081 HV Amsterdam, Netherlands
4Intensive Care Unit, Medisch Spectrum Twente, 7511 JX Enschede, Netherlands
5Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, 1081 HV Amsterdam, Netherlands
6Department of Surgery, Medical Center Alkmaar and Trial Center Holland Health, Alkmaar, Netherlands
7Department of Pediatrics, VU University Medical Center, 1081 HV Amsterdam, Netherlands
8Department of Pediatrics, Emma Children’s Hospital, AMC, 1105 AZ Amsterdam, Netherlands

Received 24 October 2015; Revised 10 February 2016; Accepted 21 February 2016

Academic Editor: Najat Mokhtar

Copyright © 2016 Mechteld A. R. Vermeulen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Glutamine supplementation in specific groups of critically ill patients results in favourable clinical outcome. Enhancement of citrulline and arginine synthesis by glutamine could serve as a potential mechanism. However, while receiving optimal enteral nutrition, uptake and enteral metabolism of glutamine in critically ill patients remain unknown. Therefore we investigated the effect of a therapeutically relevant dose of L-glutamine on synthesis of L-citrulline and subsequent L-arginine in this group. Ten versus ten critically ill patients receiving full enteral nutrition, or isocaloric isonitrogenous enteral nutrition including 0.5 g/kg L-alanyl-L-glutamine, were studied using stable isotopes. A cross-over design using intravenous and enteral tracers enabled splanchnic extraction (SE) calculations. Endogenous rate of appearance and SE of glutamine citrulline and arginine was not different (SE controls versus alanyl-glutamine: glutamine 48 and 48%, citrulline 33 versus 45%, and arginine 45 versus 42%). Turnover from glutamine to citrulline and arginine was not higher in glutamine-administered patients. In critically ill nonseptic patients receiving adequate nutrition and a relevant dose of glutamine there was no extra citrulline or arginine synthesis and glutamine SE was not increased. This suggests that for arginine synthesis enhancement there is no need for an additional dose of glutamine when this population is adequately fed. This trial is registered with NTR2285.