Deficiency in Peripheral Glutamine Production in Pediatric Patients With Burns

摘要

NA;Plasma glutamine levels decrease in association with severe injury, which suggests that the consumption of glutamine exceeds the production of glutamine or possibly represents a deficit in the release of glutamine from skeletal muscle. The goal of this study was to assess the peripheral glutamine kinetic response to prolonged stress in children with critical injuries. To accomplish this purpose, we quantitated peripheral glutamine kinetics in vivo with the use of 5N15glutamine in 5 children with severe burns lpar;total body surface area, 74percnt; plusmn; 14percnt;semi; mean plusmn; SEMrpar; and 3 children who underwent elective scar reconstruction. In the children with severe burns, leg blood flow was significantly elevated lpar;16.2 plusmn; 2.1 vs 7.5 plusmn; 0.3 mLsol;minsol;100 mL leg volume,P .02rpar; and the arterial concentration of glutamine was significantly reduced lpar;0.31 plusmn; 0.04 vs 0.84 plusmn; 0.05 mmolsol;L,P .001rpar;. The rate of glutamine turnover within the leg was significantly reduced in the patients with acute burns, whereas the net efflux of glutamine was similar between the 2 groups. These findings suggest that plasma glutamine concentrations decrease during severe stress as a result of a deficit in peripheral glutamine release in conjunction with an increased central consumption. This preliminary study supports the notion that exogenous glutamine supplementation in pediatric patients with severe injuries may be needed because of this inadequate skeletal muscle response. lpar;J Burn Care Rehabil 2000semi;21colon;172hyphen;7rpar;