Browsing by Author "Eksteen, Joanna"
Now showing 1 - 1 of 1
Results Per Page
Sort Options
- ItemPlasma glutamine concentration among critically ill children(Stellenbosch : Stellenbosch University, 2019-03) Eksteen, Joanna; Wilson, Joanna; Blaauw, Renee; Morrow, Brenda; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Background: Glutamine is considered conditionally essential during critical illness and supplementation of the nutrient has become commonplace among adult ICU populations. However, recent concern over the safety of this practice has highlighted the need for focused research on plasma glutamine levels in specific patient groups. There is limited evidence for glutamine supplementation in children, with even les s data available on plasma concentrations within this group. The aim of this study was to describe plasma glutamine concentration among critically ill children on admission to and on day two of Paediatric Intensive Care Unit (PICU) stay, and to identify associations between plasma glutamine and markers of clinical condition, nutritional status and intake, and clinical outcome. Methods: This descriptive cross-sectional study investigated the plasma glutamine concentrations of patients admitted to a tertiary PICU in the Western Cape, South Africa, over a period of one month. Plasma glutamine was analysed using blood samples collected on admission, and on day two of PICU stay. Markers of clinical condition on admission (diagnostic profile, severity of disease, presence of infectious disease, and routine biochemistry) were collected. Age-appropriate anthropometry was conducted, and the nutritional status of participants was assessed using World Health Organization Z scores. Nutritional intake was recorded and analysed for the first two days of PICU stay. Results: Seventy six participants were included in this study, many of whom (47%) were post-operative cardiac patients. Plasma glutamine concentrations were normal for most participants on admission (median 556.5 umol/l, IQR 459- 664.5 umol/l) and on day two of PICU stay (median 529.0 umol/l, IQR 356.0-716.0 umol/l). No obvious change in plasma levels occurred during this period. Significant differences in plasma glutamine were found between medical and elective surgery (p = 0.007) and trauma (p = 0.013) patients with trauma observed to have the lowest concentrations on admission (mean 450.3 ± 166.7 umol/l). Differences were also observed between cardiology and gastroenterology (p = 0.018), and between sepsis and pulmonology (p = 0.031), burns (p = 0.035), gastroenterology (p = 0.006), and ‘other’ (p = 0.049) diagnoses. Participants with sepsis had the highest plasma glutamine on admission (mean 736.3 ± 142.5 umol/l). Participants with higher plasma glutamine on admission tended to have longer hospital stays (p = 0.067), and a higher mortality risk (p = 0.052). Although no link was made with mortality, those who died had higher plasma glutamine on day two of PICU stay (p = 0.057). Conclusion: This study found normal plasma glutamine concentrations among critically ill children over the first two days of PICU stay. Significant differences were found in plasma glutamine between diagnostic groups, with sepsis and trauma identified as areas for future study. A tendency was demonstrated toward poorer outcome and increased mortality risk among those with high plasma glutamine. Additional exploratory research is required to better understand plasma glutamine in different paediatric subgroups.