Enteral administration of glutamine in purulent peritonitis

The intestinal hypomotility associated with purulent peritonitis is general ly regarded as a contraindication to enteral nutrition. However, enteral nu trition may be feasible in suppurative peritonitis if administered with gre at caution, i.e., assuring the appropriate amount, delivery speed, and osmo lality of the enteral formulation. Glutamine (Gln) increases muscle protein synthesis and decreases muscle protein degradation in sepsis, regardless o f the route of administration. Therefore, administering small amounts of su pplemental Gin via the enteral route to peritonitis patients may be benefic ial. Two purulent peritonitis patients received L-Gln through a jejunostomy tube. The average amount of supplemental Gln was 16 g/d. Systemic inflamma tory responses, i.e., high temperature and a high serum C-reactive protein level, persisted throughout the treatment period. Femoral arterial and veno us blood samples were drawn simultaneously for determination of amino acid levels before and after 7 d of Gin supplementation. Enterally administered Gln was well-tolerated by both patients. There was an increase in plasma Gi n levels after Gin supplementation. Moreover, the release of Gin, alanine, and phenylalanine from the lower extremities was lower after as compared to before Gin supplementation. Enteral administration of Gin may be feasible even in purulent peritonitis. Nutrition 1999;15:29-31. (C) Elsevier Science Inc. 1999.