THE EFFECT OF L-GLUTAMINE ON SALT AND WATER-ABSORPTION - A JEJUNAL PERFUSION STUDY IN CHOLERA IN HUMANS

Objectives: To assess the efficacy of an L-glutamine solution on jejun al salt and water absorption in cholera patients. Design: A randomized double-blind jejunal perfusion study. Setting: International Centre f or Diarrhoeal Disease Research, Bangladesh. Patients: Nineteen adults with acute cholera. Interventions: Perfusion of balanced salt solution s alternated with defined glucose salt solution and glutamine glucose salt or alanine glucose salt solutions. Main outcome measures: Net jej unal water and sodium secretion. Results: Perfusion of glutamine in th e presence of glucose significantly reduced net water secretion (J(net )(H2O) = -2.6 +/- 1.3 ml/h/cm) and also reduced net sodium secretion ( J(net)(Na) = 213 +/- 153 mu mol/h/cm). Similar results were observed d uring the perfusion of solutions that contained alanine in addition to glucose (J(net)(H2O) = -4.2 +/- 1.1 ml/h/cm and J(net)(Na) = -444U +/ - 142 mu mol/h/cm, respectively) or glucose alone (J(net)(H2O) = -4.3 +/- 1.7 ml/h/cm and J(net)(Na) = -452 +/- 212 mu mol/h/cm, respectivel y). In addition, a higher basal secretion was associated with a greate r stimulation of water absorption (F = 17, P<0.001). Conclusion: Gluta mine in the presence of glucose significantly reduces net water secret ion and also reduces sodium secretion; higher basal secretion is assoc iated with greater water absorption. As glutamine is able to stimulate water absorption to the same degree as glucose and alanine, and becau se it has the theoretical advantage of providing fuel for the mucosa, the inclusion of glutamine as the sole substrate in oral rehydration s olution warrants further study.