Evidence for Glutathione Supplementation in Critically Ill Patients

Critical Distinction: Glutathione vs. Glutamine

• The European Society for Clinical Nutrition and Metabolism (ESPEN) provides a Grade A recommendation stating that additional high-dose parenteral glutamine SHALL NOT be administered in critically ill patients with acute kidney injury or chronic kidney disease 1
• Grade A evidence exists AGAINST high-dose parenteral glutamine in critically ill patients with organ dysfunction, as demonstrated by the landmark REDOXS trial showing increased mortality 1
• The available evidence primarily addresses glutamine rather than glutathione, with most clinical trials and guidelines focusing on glutamine supplementation 2, 3

Evidence Grading Summary

• The American Society for Parenteral and Enteral Nutrition recommends against routine administration of high-dose parenteral glutamine in critically ill patients with organ dysfunction, due to increased mortality 1
• Indiscriminate supplementation of glutamine may cause harm rather than benefit in critically ill patients 2, 3