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Our analysis showed that hospitals in the lowest-performing quartile of the Safety of Care measure group tended to receive lower Overall Hospital Quality Star ( Ratings (being more likely to receive 1 or 2 stars and less likely to receive 4 or 5 stars than other hospitals) (Table 141)

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30 Bajis S , Grebely J , Cooper L , Smith J , Owen G , Chudleigh A , et al

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However, because the metabolism of glutamine produces ammonia as a byproduct, taking excessively large single doses can overwhelm the liver's ability to process the nitrogen, leading to transient nausea, upper GI discomfort, or belching