Efeito da glutamina na permeabilidade intestinal, evolução clínica e toxicidade renal em crianças com diarréia persistente e desnutrição

Abstract

The malnutrition appears when the organism doesn't receive the necessary nutrients to its metabolism. The persistent diarrhea is pointed as cause and effect of malnutrition and it increases the death risk when associated to it. Glutamine is the most abundant amino acid in the blood, being considered the main energy source and the precursory for proteins and nucleotide synthesis in the intestinal epithelium. The objectives of this study were to evaluate the intestinal permeability with the use of Lactulose/Manitol test (L/M) in patients with persistent diarrhea (14 days < diarrhea <30 days) and malnutrition, determining the safety and effectiveness of glutamine, added to the Oral Reydration Solution (ORS), in the recovery of those children's intestinal epithelium and the estimation of weight gain of those children. Fiffy-two children aged between two and sixty months were selected to participate on this clinicai trial, double blind, random and with control, having accomplished urea and creatinina measurements in the beginning and at the end of this study. However, forty-one had all the lactulose and manitol measurements using high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD), before and after the use of ORS with glutamine (ORS-Gln) or ORS of the World Health Organization (ORS-WHO). When we compared the control group (ORS-WHO) with the test group (ORS-Gln) regarding manitol, we found a tendency to a larger loss of the intestinal absorptive area with the use of ORS-WHO compared with ORS-Gln, although it has not been found statistical significance (p = 0,849 in control group and p = 0,816 in test group). The control group (ORS-WHO) had significant increase on the measurements of initial and final lactulose and on the Lactulose/Manitol (L/M) initial and final ratio, with values of p = 0,039 and p - 0,044 respectively. The test group (ORS-Gln) had a decrease, with no significance, on the values of final lactulose in relation to the initial and a tendency to the maintenance of the same values of the L/M ratio. The urea and creatinina measurements didn't present differences when compared both groups and no side effect was observed in this study. Regarding the weight, this study demonstrated a significant weight gain in the group that used ORS-Gln in relation with the group that used ORS-WHO, with values of p = 0,002 and p = 0,33 respectively. This study concluded that the use of an ORS with glutamine in children with persistent diarrhea and malnutrition reduces the evolution of the intestinal epithelium lesion, doesn't cause renal toxicity and improves the weight gain in these children.