Nutrition Support Blog: Update from CNW--Pharmaconutrition: Supplementation, Shortages, and Snags
February 12, 2013
Thanks to our teammate, Kendra Glassman, for sharing
updates from Clinical Nutrition Week! Also check out her
February 11th blog for more of the latest news!
To see this blog and other updates from CNW, visit the ASPEN Connect page of the ASPEN website (http://community.nutritioncare.org/Home) and view all the Recent Blogs.
Pharmaconutrition: Supplementation, Shortages, and Snags
The controversy continues on whether or not to give glutamine and other nutrients to our critically ill patients. Dr. Wischmeyer opened his talk by asking the audience if they would give potassium supplementation to a patient with a potassium level of 6.8 and again asked if supplementation is warranted with a potassium of 2.0. He then suggested this same rationale should be used in supplementing the critically ill patient with glutamine. An interesting analogy, but do we really know the mechanism for abnormal glutamine levels in the critically ill? Is a low level a true deficiency and will supplementation help? Have we not been down this road before with other nutrients such as Vitamin E and arginine? He then concluded with recommendations from the Canadian Clinical Care guidelines stating glutamine supplementation in the critical ill should be considered. What does this mean to the average clinician following these guidelines? My take home message from the recent results of the REDOXs trial as well as the available research on glutamine is WE NEED MORE DATA before routine supplementation of glutamine is considered in the critically ill.
Next, we learned about the available research on zinc supplementation. Again, more research is needed as the data is weak and the populations have been heterogeneous. A robust, randomized, controlled study is underway, however, enrollment is crawling due to the parenteral trace element shortages in the U.S. I couldn’t help but think at this juncture, zinc should not be allocated to support research studies, but should instead be supplied to the numerous hospitals that are currently unable to provide adequate zinc supplementation due to the shortages.
This is clearly an exciting time of nutrition research as there are numerous questions left unanswered. This session made me realize just how much more research is needed, yet the recent ongoing shortages may halt such research in order to provide our patients with sufficient micronutrient supplementation.