Glutamine’s role in severe burns

Date:

05-Nov-2001

Source

Crit Care Med

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Article

Fourth degree burns, also called full thickness burns, affect the full skin thickness and underlying subcutaneous tissue, including the fat, fascia, muscle, and sometimes bone. They have a blackened appearance, are dry and generally not painful. They carry the danger of deep infection. Major burns require emergency treatment at a local hospital followed by transport to a regional burn facility for specialized definitive care. Major burns are classified by the following: More than 10 percent of body surface area (BSA) if a full thickness burn, burns due to caustic chemical agents or high voltage electricity, or burns complicated by inhalation injury, major trauma, or poor risk patients.

Sever injury, such as burns, cause plasma glutamine levels to decline substantially. In one study, patients with major burn injuries, the plasma glutamine concentration was 58% lower than that in normal controls and it remained low for at least 21 days after the injury. These findings indicate that the decrease in plasma glutamine concentration may contribute to the injury-induced impairment of immune function occurring after major burn injury.1 A recent study examined the effects of glutamine versus isonitrogenous control in severely burned patients.

The object of this study was to determine the effects of a glutamine IV or an isonitrogenous IV (amino acid solution) on morbid infection in severely burned patients. In a burn unit of a hospital, 27 burn patients having a BSA of 25% to 90% and full thickness burns were the subjects of this study. Data were recorded for their overall inflammation, nutritional status, and the occurrence of bacteremia and antibiotics were used during the first 30 days of their burn unit admission. Patients were given intravenously either the amino acid solution or the glutamine. The incidence of bacteremia was reduced significantly in the glutamine group versus the amino acid group. Significant improvements were also seen in serum levels of transferrin (protein that transfers iron) and prealbumin (transfers thyroxine). C-reactive protein, a protein present in the bloodstream when there is inflammation, was also greatly reduced after 14 days of the glutamine treatment. In addition, a trend towards a lower mortality rate was observed in the glutamine group. The authors concluded, “Glutamine's beneficial effects may be a result of improved gut integrity or immune function, but the precise mechanism of glutamine's protection is unknown.”2

References

1. Parry-Billings M, et al. Does glutamine contribute to immunosuppression after major burns? Lancet. Sep1990;336(8714):523-5.
2. Wischmeyer PE. Glutamine administration reduces Gram-negative bacteremia in severely burned patients: A prospective, randomized, double-blind trial versus isonitrogenous control. Crit Care Med. Nov 2001; 29(11):2075-2080.