Sobre los usos, aplicaciones y beneficios de las soluciones parenterales de glutamina

Alfredo Matos Adames; Sergio Santana Porbén

Sobre los usos, aplicaciones y beneficios de las soluciones parenterales de glutamina

Alfredo Matos Adames, Sergio Santana Porbén

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Resumen

El conocimiento de las propiedades farmacológicas de la glutamina (Gln) ha provisto el estímulo para el desarrollo de la Inmunonutrición como especialidad de la terapia nutricional y el apoyo nutricional mediante la inclusión de este aminoácido en productos enterales, o como soluciones de dipéptidos para la incorporación dentro de regímenes de nutrición parenteral. Varios cuerpos de expertos recomiendan el uso de los dipéptidos de Gln en situaciones clínico-quirúrgicas como el trauma y la cirugía de las vías digestivas. Varios estudios han sugerido beneficios tangibles tras el uso de los dipéptidos de Gln en en estas situaciones. Sin embargo, el empleo de la Gln como fármaconutriente, y hasta la propia existencia de la especialidad de la Inmunonutrición, fueron puestos en duda tras los resultados de los ensayos REDOXS (Heyland et al., 2013) y MetaPlus (van Zanten et al., 2014), los que concluyeron que la administración exógena de Gln (en cualquier forma de presentación farmacéutica) podría significar un mayor riesgo de mortalidad para los pacientes críticamente enfermos. Los análisis post-hoc de los ensayos antes citados revelaron importantes falencias del diseño metodológico de los mismos, y una pobre definición de los objetivos de la suplementación exógena con Gln. En la resaca de los resultados de los ensayos REDOXS y MetaPlus se han conducido nuevos meta-análisis y revisiones sistémicas que confirman la efectividad de las soluciones de la Gln como parte de los esquemas de repleción nutricional que se conducen en las unidades de cuidados críticos. También se han emitido nuevas recomendaciones y pautas sobre la mejor selección de los pacientes que se beneficiarían máximamente de la administración de Gln, las precauciones que se deben observar con estos preparados farmacológicos, y las contraindicaciones para el uso de la Gln. Se avizora una nueva era de (re)descubrimientos del lugar de la Gln en la terapia nutricional.

Palabras clave

Glutamina; Dipéptidos; Nutrición parenteral; Cuidados críticos

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