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Carnitine deficiency in chronic critical illness
Luisa Bonafé1, Mette M Berger, Yok Ai Que
1aCenter for Molecular Diseases, Lausanne University Hospital bAdult Intensive Care & Burns, Lausanne University Hospital, Lausanne, Switzerland cDivision of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Current Opinion in Clinical Nutrition and Metabolic Care
|February 7, 2014
Summary
Carnitine deficiency is common in critically ill patients, impacting mitochondrial function and beta-oxidation. Supplementation is recommended when carnitine levels are low, though specific guidelines are lacking.
Area of Science:
- Mitochondrial Physiology
- Metabolic Disorders
- Critical Care Medicine
Background:
- Mitochondrial dysfunction is key in chronic critical illness.
- Carnitine status significantly impacts metabolic and neuroendocrine changes.
- This review focuses on carnitine's role in beta-oxidation and mitochondrial function in critically ill patients.
Purpose of the Study:
- To highlight the importance of carnitine status in chronic critical illness.
- To elucidate carnitine's impact on beta-oxidation and mitochondrial function.
- To provide recommendations for carnitine assessment and supplementation.
Main Methods:
- Review of current literature on carnitine physiology and critical illness.
- Analysis of risk factors for carnitine depletion.
- Discussion of diagnostic methods for carnitine deficiency.
- Formulation of supplementation recommendations.
Main Results:
- Carnitine facilitates long-chain fatty acid transport into mitochondria for beta-oxidation.
- Risk factors for carnitine depletion include prolonged renal replacement therapy and parenteral nutrition.
- Impaired beta-oxidation due to carnitine deficiency can lead to hypertriglyceridemia, hyperlactatemia, and multiorgan failure.
- Measurement of plasma carnitine, amino acids, acylcarnitines, and urinary organic acids is recommended.
- Supplementation with 0.5-1 g/day is suggested for carnitine levels below 20 μmol/l.
Conclusions:
- Carnitine deficiency is an important, measurable aspect of metabolic changes in chronic critical illness.
- Early detection and substitution of carnitine can address a significant contributor to critical illness complications.
- Further research is needed to establish formal guidelines for carnitine management in this population.
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