The local vascular tolerance to an intravenous infusion of a concentrated glutamine solution in ICU patients

Background and aims: The beneficial effects of glutamine is well-documented in ICU patients. However, the documentation and control of enteral administration of glutamine is still insufficient. As an adjunct to enteral nutrition, a concentrated dipeptide solution may be given in a central venous line, but administration via a peripheral vein would be preferable. Therefore, we systematically evaluated local vascular tolerance following a concentrated dipeptide infusion in ICU-patients. Methods: ICU-patients (n=20) were randomized to receive a 20% alanyl-glutamine infusion of 0.5 g/kg or placebo during 4 h in a peripheral vein on 3 consecutive days. Local tolerance was evaluated clinically, by Maddox score, and ultrasonically before the infusion and on days 1, 4 and 8 after the infusion. Results: In the study, 56 out of 60 (93%) planned infusions were administered and 157 out of 168 (93%) clinical evaluations were successfully performed. The ultrasonic evaluation revealed that the utilized veins had a diameter of 2.15±0.8 mm (range, 1.0––4.4 mm). There were no signs of thrombophlebitis in any single vein. Conclusion: Administration of a glutamine-containing dipeptide concentrate (20%) by peripheral veins is safe in terms of local tolerance, if a strict protocol is adapted for this purpose is used.