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Longitudinal pattern of glutamine/glutamate
balance across the leg in long-stay intensive
care unit patients R. F. Vesali, M. Klaude, O. E.
Rooyackers, I. Tjäder, H. Barle and J.
Wernerman Clinical Nutrition 2002. 21, 505-514
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Aims
? How long can glutamine release from skeletal
muscle continue in ICU patients?
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Glutamine ? Most abundant amino acid in the
body ? During stress, it is a conditionally
essential amino acid ? Glutamine concentration in
muscle decreases in ICU patients ? Low plasma
concentration in ICU patients is associated with
high mortality
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Study protocol study I
1 2 3 4
5 6 7
Study occasion
plasma sampling and blood flow measurement
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Plasma glutamine concentration in ICU patients on
2-7 consecutive study occasions
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Plasma glutamate concentration in ICU patients on
2-7 consecutive study occasions
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Net balance (NB) (A - V) ? BF NB
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Net balance of glutamine across leg muscle of ICU
patients on 2-7 consecutive study occasions
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Net balance of glutamate across leg muscle of ICU
patients on 2-7 consecutive study occasions
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Aims
? How long glutamine release of skeletal muscle
can continue in ICU patients? ? Does degradation
of skeletal muscle protein change over time?
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Phenylalanine 3-Methyl histidine
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Phenylalanine 3-Methyl histidine
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Net balance of phenylalanine across leg muscle of
ICU patients on 2-7 consecutive study occasions
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Phenylalanine 3-Methyl histidine
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Net balance of 3-Methylhistidine across leg
muscle of ICU patients on 2-7 consecutive study
occasions measured by HPLC
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Conclusions
During the initial 2 weeks of ICU stay ? The
export of glutamine and uptake of glutamate did
not change over time. ? The negative net balance
of phenylalanine indicated a constant net protein
degradation over time. ? The negative net balance
of 3-methylhistidine indicated a constant
degradation of contractile proteins over time.
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THE END
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The depletion of skeletal muscle protein in ICU
patients Discrepancies between synthesis and
degradation 1. Synthesis
Degradation 2. Synthesis
Degradation 3. Synthesis
Degradation 4.
Synthesis
Degradation 5. Synthesis
Degradation