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Prolonged continuous renal replacement therapy (CRRT) in critically ill patients can lead to deficiencies in carnitine and copper, causing neurological issues. Supplementation rapidly improved the patient's condition, highlighting the importance of monitoring these micronutrients.

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Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Infectious Diseases

Background:

  • Critically ill patients with severe SARS-CoV-2 infection often require intensive care unit (ICU) support.
  • Acute kidney injury (AKI) is a common complication, necessitating continuous renal replacement therapy (CRRT).
  • Nutritional support is crucial but may not prevent all metabolic derangements.

Observation:

  • A 60-year-old male with SARS-CoV-2 induced respiratory failure developed AKI requiring prolonged CRRT.
  • Despite enteral feeding, the patient experienced significant muscle atrophy and weight loss.
  • Progressive unresponsiveness was noted on day 85, associated with hyperammonemia and hypertriglyceridemia.

Findings:

  • Metabolic workup revealed low plasma free carnitine and copper levels.
  • Carnitine supplementation led to rapid neurological improvement.
  • Associated metabolic abnormalities, including hyperammonemia and hypertriglyceridemia, also regressed.

Implications:

  • Prolonged CRRT can deplete essential micronutrients like carnitine and trace elements such as copper.
  • Monitoring and supplementation of these deficiencies are critical for managing critically ill patients.
  • This case underscores the potential for CRRT-induced nutrient depletion to cause severe clinical manifestations.