Glutamine, glutamate and citrulline concentration in blood plasma in patients in critical condition (pilot study results)

Abstract

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 (HGS) and glutamatergic system normofunction (NGS). HGS condition is associated with more expressed proximal small intestine EA and less 28-day RD survival (р<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. HGS or NGS condition is characteristic for patients in extremely critical condition (with АРАСНЕ 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.