Background The administration of glutamine (GLU) intravenously as part of protein intake in patients who are given parenteral nutrition (PN) is associated with fewer infectious complications, shorter hospital stay and, possibly, reduced mortality in critically ill patients.
Purpose To examine the use of GLU in clinical practice as a supplementation to PN according to the product information and recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN).
Materials and methods A descriptive, observational study included patients who received PN GLU supplementation from January 2012 to June 2012. The following data were collected from electronic medical records and from MedicalOne Parenteral software: prescribing service, indication, weight, GLU dose, creatinine clearance (CrCl), liver disease and length of treatment with GLU.
Results Of the 282 patients who received PN, 36 (12.8%) received GLU. The indication for the prescription of GLU was: 24: major abdominal surgery (66.7%), 7: critical illness (19.4%), 3: acute pancreatitis (8.33%) and 2: mucositis (5.7%). The weight was recorded in 22 of the 36 patients, range 45 to 108 kg (median 60). 100 ml of alanyl-glutamine was administered to all GLU patients (82 mg alanine + 134.6 mg glutamine); 7 patients were underdosed (31.8%) considering that the recommended dose is 1.5–2.5 ml/kg. 2 patients (5.5%) had severe renal dysfunction (CrCl <25 ml/min) and 2 (5.5%) severe liver disease, situations in which the administration of GLU is contraindicated. The time range of GLU administration was 1–28 days (median: 6). Experience in using GLU for more than 9 days is limited, yet the product information indicates that the length of treatment should not exceed 21 days. In 11 patients (30.5%) treatment extended to 9 days, and in 1 patient (2.8%) over 21 days.
Conclusions The use of GLU meets the recommendations of the product information and ESPEN in terms of indication. However, we found some errors in terms of dose, contraindications and length of treatment. Through clinical monitoring of patients and validation of PN prescription, the pharmacist is key to alerting the doctor about these GLU prescription and administration errors in critically ill patients.
No conflict of interest.
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