Repercussions of l-alanyl-glutamine upon the concentrations of lactate and lactate dehydrogenase (LDH) in patients with critical ischemia of lower limbs subjected to distal revascularization

• Autor(es):

  Alves, Wellington Forte (Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Cirurgia);

  Guimarães, Sérgio Botelho (Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Cirurgia);

  Vasconcelos, Paulo Roberto Cavalcante de (Universidade Federal do Ceará);

  Vasconcelos, Paulo Roberto Leitão de (Universidade Federal do Ceará. Faculdade de Medicina).

• Fonte:

  Acta Cirurgica Brasileira; volume 18, número 3. Junho 2003.

• Assuntos:

  Metabolism;

  Ischemia;

  Reperfusion;

  Lactic acid.

• Resumo:

  PURPOSE: Investigate the repercussions of L-alanyl-glutamine in muscular tissue concentrations of lactate, and venous and arterial blood concentrations of LDH, in patients with critical ischemia of the lower limbs submitted to distal revascularization. METHODS: Sixteen adults (12 male/4 female) were distributed in 2 groups (1-Control/2-Experiment). Three hours after the intravenous injection of 250 ml of a 20% solution of L-alanyl-glutamine added to 750 ml of saline solution (Group 2); or 1000 ml of saline solution (Group 1), distal bypass was carried out under spinal anesthesia. Muscle and blood samples (arterial/venous) were collected at the beginning of the surgical procedure (TI), at the end (TF), and 10 and 20 minutes after re-establishment of blood flow. RESULTS: Significant reduction (p<0,05) of lactate concentration was observed in healthy muscle tissue in L-alanyl-glutamine treated patients in comparison to control group, at all times studied. There was a significant reduction (p <0,05) in venous concentrations of LDH in treated patients at all times studied (TI/TFV/T1V/T2V); and in arterial blood during reperfusion (T1A/T2A). CONCLUSIONS: 1. Decreased lactate concentrations in healthy skeletal muscle in patients treated with L-alanyl-glutamine suggests greater utilization of pyruvate for energy production than its conversion to lactate in Krebs cycle boosting aerobic glycolysis. 2. - Drop in venous blood concentrations of LDH in treated patients with L-alanyl-glutamine at all times during ischemia, and 10 and 20 minutes after reperfusion, also suggests augmented utilization of pyruvate for energy production via aerobic glycolysis.

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