Exudative glutamine losses contribute to high needs after burn injury.

Background Burn patients characteristically have increased energy, glucose and protein requirements. Glutamine supplementation is strongly recommended during early phase treatment and is associated with improved immunity, wound healing, and reduced mortality. This study evaluated if early burn exudative losses might contribute to higher supplementation needs. Methods Patients admitted to the burn intensive care unit (ICU) had exudate collection from tight bandages applied to arms or legs during the first week (exudate aliquot twice daily). Seven amino acids (alanine, arginine, cystine, glutamine, leucine, lysine, methionine) were quantified by liquid chromatography-mass spectrometry. Descriptive analysis of all results is provided as in medians and interquartile ranges or in value ranges. Results Eleven patients aged 19 to 77 years, presenting with burns on 18 to 70% of body surface, with a median SAPSII 33 (range 16 to 56) were included during the study period. The highest amino acid losses were observed during the first 3 days with an important inter- and intra-patient variability. Glutamine and alanine losses were highest, followed by leucine and lysine in all patients: amino acid exudate concentrations were in the range of normal plasma concentrations and stable over time. Total glutamine losses were correlated to burned surface (r2 = 0.552, p = 0.012), but not to enteral glutamine supplements. Conclusions The study shows significant exudative losses during early stage burn recovery and particularly for glutamine and alanine. Glutamine loss generally decreased with wound closure and subsequent decline of exudation and evolving size of burn surfaces. This article is protected by copyright. All rights reserved.