[Glutamine, glutamate and citrulline concentration in blood plasma in patients in critical condition (pilot study
Insights
In critical condition patients, altered glutamate levels correlate with gastrointestinal electrical activity and survival. Hypofunction of the glutamatergic system is linked to worse outcomes and impaired gut motility.
Area of Science:
- Critical care medicine
- Gastroenterology
- Biochemistry
Context:
- Patients in critical condition (CC) often experience gastrointestinal dysfunction.
- The role of the glutamatergic system in CC-related gut motility disorders is not fully understood.
Purpose:
- To evaluate plasma levels of glutamine, glutamate, and citrulline in relation to small intestine electrical activity in critically ill patients.
- To compare these parameters with patient outcomes, including 28-day survival.
Summary:
- Plasma levels of glutamine, glutamate (Gl-p), and citrulline (Cit-p) were measured in 27 critically ill patients.
- Patients were categorized into glutamatergic system hypofunction (HCS) or normofunction (NGS) based on Gl-p and Cit-p levels.
- HCS was associated with increased proximal small intestine electrical activity (EA) and reduced 28-day survival.
Impact:
- Findings suggest the glutamatergic system's involvement in the pathogenesis of gastrointestinal motor activity disorders in CC.
- Altered glutamate metabolism and small intestine EA may serve as potential diagnostic markers.
- This research supports the rationale for correcting glutamatergic hypofunction in critically ill patients.
Unlabelled:
Study objective was to evaluate and to compare glutamine, glutamate and citrulline plasma levels (Glu-p, Gl-p, Cit-p) with electrical activity indicators (EA) from the proximal small intestine in patients in critical condition (CC).
Materials And Methods:
27 patients in CC (15 women, 12 men, 70 +/- 14 years, from them "therapeutic profile" patients--12, "surgical"--15) have been surveyed and treated. At admission to reanimatology department (RD) Glu-p, Gl-p, Cit-p (by highly effective liquid chromatography), relative duodenal and jejunum EA--by peripheral electrogastrography--have been measured. Patients' 1st day general condition and 28-day survival rates in the RD were assessed by various scales. Glutamine preparations have not been administered.
Results:
Relatively to norm Glu-p, Gl-p, Cit-p increase has not been observed. By Gl-p and Cit-p maintenance patients were classified into 2 clusters, nominally named accordingly to decreased or normal Gl-p level as glutamatergic system hypofunction condition (HCS) and glutamatergic system normofunction (NGS). HGS condition is associated with more expressed proximal small intestine EA and less 28-day RD survival (p < 0.05), the worst prognosis was observed in case of combination of more signified proximal small intestine relative EA depression with subnormal Gl-p or Cit-p less than 10 mcmol/l.
Conclusion:
HCS or NGS condition is characteristic for patients in extremely critical condition (with APACHE II 30 (24; 38)). Conjunction of glutamate (Gl) and its' biochemical metabolism indicators maintenance alterations in peripheral blood, small intestine EA parameters and 28-day survival rates in RD shows the participation of glutamatergic system in pathogenesis of functional gastrointestinal tract motor activity disorders in patients in CC, possible diagnostics courses and rationality of its hypofunction correction.
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