Glutamine in the ICU: who needs supply?

Many ICU patients are glutamine depleted and have low glutamine plasma concentrations. Beneficial effects by glutamine supply could be proven in these patients. In some medical conditions, especially those with acute right heart failure, elevated glutamine plasma concentrations are present and glutamine supply may be disastrous and a toxic burden. It will be prudent to reassess the use of glutamine in ICU especially in conditions with unresolved shock or right heart failure.