Skip Navigation LinksHome > March 2014 - Volume 17 - Issue 2 > Carnitine deficiency in chronic critical illness
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Current Opinion in Clinical Nutrition & Metabolic Care:
doi: 10.1097/MCO.0000000000000037
NUTRITION AND THE INTENSIVE CARE UNIT: Edited by Jeffrey I. Mechanick and Mette M. Berger

Carnitine deficiency in chronic critical illness

Bonafé, Luisaa; Berger, Mette M.b; Que, Yok Aib; Mechanick, Jeffrey I.c

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Abstract

Purpose of review

New insight in mitochondrial physiology has highlighted the importance of mitochondrial dysfunction in the metabolic and neuroendocrine changes observed in patients presenting with chronic critical illness. This review highlights specifically the importance of carnitine status in this particular patient population and its impact on beta-oxidation and mitochondrial function.

Recent findings

The main function of carnitine is long chain fatty acid esterification and transport through the mitochondrial membrane. Carnitine depletion should be suspected in critically ill patients with risk factors such as prolonged continuous renal replacement therapy or chronic parenteral nutrition, and evidence of beta-oxidation impairments such as inappropriate hypertriglyceridemia or hyperlactatemia. When fatty acid oxidation is impaired, acyl-CoAs accumulate and deplete the CoA intramitochondrial pool, hence causing a generalized mitochondrial dysfunction and multiorgan failure, with clinical consequences such as muscle weakness, rhabdomyolysis, cardiomyopathy, arrhythmia or sudden death. In such situations, carnitine plasma levels should be measured along with a complete assessment of plasma amino acid, plasma acylcarnitines and urinary organic acid analysis. Supplementation should be initiated if below normal levels (20 μmol/l) of carnitine are observed. In the absence of current guidelines, we recommend an initial supplementation of 0.5–1 g/day.

Summary

Metabolic modifications associated with chronic critical illness are just being explored. Carnitine deficiency in critically ill patients is one aspect of these profound and complex changes associated with prolonged stay in ICU. It is readily measurable in the plasma and can easily be substituted if needed, although guidelines are currently missing.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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