Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis

Background: The management of acute pancreatitis (AP) frequently includes parenteral nutrition, but conditionally essential amino acids such as glutamine are not included in conventional total parenteral nutrition (TPN). Aim: This study was conducted to determine whether the inclusion of glutamine has a beneficial effect in patients with AP receiving TPN. Methods: In a randomized, controlled study 28 patients with AP received either a standard TPN with 1.5 g/kg body weight protein or an isonitrogen, isocaloric TPN which contains 0.3 g/kg -alanine- -glutamine. Patients were assessed for nutritional and inflammatory parameters, infectious complications, length of TPN, length of hospital stay (LOS) and cost of TPN. Results: There were no side-effects related to glutamine substitution observed. Glutamine was associated with a significant increase of cholinesterase, albumin and lymphocyte count in AP as well a decrease of C-reactive protein compared to standard TPN at day 14. There was a reduced length of TPN (10 [6–16] vs 16 [10–18] days, P<0.05) and a trend of reduced LOS (21 [14–32] vs 25 [19–40] days) in AP patients receiving glutamine. The overall cost per patient for TPN did not differ (gln+: 929±586 vs gln−: 981±507 euro/patient). Conclusion: Our results suggest that glutamine substitution is beneficial and does not increase the overall cost of parenteral feeding in patients with acute pancreatitis.