L-Glutamine Supplementation in Specific Clinical Conditions

Parenteral Nutrition in Acute Pancreatitis

When enteral nutrition is not feasible in severe acute pancreatitis, parenteral glutamine should be supplemented at 0.20 g/kg per day, as it has been shown to reduce infectious complications, mortality, and hospital stay in patients receiving total parenteral nutrition 1
Meta-analyses demonstrate that the benefit of glutamine supplementation appears specific to the parenteral route, with significant improvements in outcomes for patients receiving total parenteral nutrition 1

In perioperative settings, glutamine supplementation (0.4-0.5 g/kg/day parenterally) has shown no effect on surgical morbidity or mortality in the largest trials, although one meta-analysis found a modest reduction in hospital length of stay 2

The European Society for Clinical Nutrition and Metabolism (ESPEN) states that there are insufficient consistent clinical data to recommend glutamine during conventional cytotoxic or targeted therapy 5
The Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) recommend against intravenous glutamine for preventing oral mucositis in patients receiving high-dose chemotherapy 3
Glutamine is metabolized at high rates by cancer cells and has been associated with higher tumor relapse rates in hematopoietic stem cell transplantation patients, representing a major unresolved safety issue 5, 6