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Author Notes:

Correspondence: Thomas R. Ziegler, Suite GG-23, General Clinical Research Center, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322; Phone: (404) 727-7351; Fax: (404) 727-5563; Email: tzieg01@emory.edu

Acknowledgments: The authors thank the nursing staff of the Emory University Hospital Surgical Intensive Care Units and Ewald Schlotzer, Ph.D., of Fresenius-Kabi for their support of this study.


Research Funding:

Supported by Emory General Clinical Research Center (GCRC) grant M01 RR00039, a grant from Fresenius-Kabi (TRZ), and USDA Agricultural Research Service Cooperative Agreement 58-1950-4-40 (JBB).


  • α-tocopherol
  • critical illness
  • glutathione
  • parenteral nutrition
  • vitamin C
  • zinc

Depletion of Plasma Antioxidants in Surgical Intensive Care Unit Patients Requiring Parenteral Feeding: Effects of Parenteral Nutrition With or Without Alanyl-Glutamine Dipeptide Supplementation

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Journal Title:



Volume 24, Number 1


, Pages 37-44

Type of Work:

Article | Post-print: After Peer Review


Objectives Antioxidant depletion is common in critically ill patients. This study was designed to determine the effects of PN, with or without glutamine (Gln) supplementation, on systemic antioxidant status in adult patients after major surgery who required parenteral nutrition (PN) in the surgical intensive care unit (SICU) setting. Methods Fifty-nine SICU patients who required PN following pancreatic surgery or cardiac, vascular or colonic (non-pancreatic) surgery were randomized in a double-blind study to receive standard PN (Gln-free) or Gln-supplemented PN (Gln-PN) in which Gln was provided as alanyl-Gln dipeptide. Conventional PN vitamin and mineral doses were administered to all subjects. Plasma concentrations of the antioxidant glutathione (GSH) and the anti-oxidant nutrients α-tocopherol, vitamin C and zinc were determined at baseline (initiation of study PN) and again after 7 days of study PN. Data were analyzed for the total study cohort and within the pancreatic surgery and non-pancreatic (cardiac, vascular and colonic) surgery patient subgroups. Results Mean plasma antioxidant concentrations were within or slightly below the normal ranges at baseline. However, a high percentage of patients demonstrated below normal baseline plasma concentrations of GSH (59%), vitamin C (59%) and zinc (68%), respectively. A lower percentage of patients exhibited below normal plasma α-tocopherol levels (21%). Study PN significantly improved plasma zinc levels in the entire study group and each surgical subgroup. Gln-PN significantly improved the change in plasma reduced GSH from baseline to day 7 in the non-pancreatic surgery patients (PN: −0.27 µM vs Gln-PN: +0.26 µM; p<0.03). Conclusions Low plasma levels of key antioxidants were common in this group of SICU patients despite administration of PN containing conventional micronutrients. Compared to standard PN, Gln-supplemented PN improved plasma GSH levels in SICU patients after cardiac, vascular or colonic operations.

Copyright information:

© 2008 Elsevier Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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