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may alleviate the metabolic abnormalities of patients with inborn errors that result in accumulation of toxic organic acids. Conditions for which this effect has been demonstrated are: glutaric aciduria II, methyl malonic aciduria, propionic acidemia, and medium chain fatty acylCoA dehydrogenase deficiency. Berger MM, Reintam-Blaser A, Calder PC, Casaer M, Hiesmayr MJ, Mayer K, et al. Monitoring nutrition in the ICU. Clin Nutr. 2019;38(2):584–93.
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. ( 23092397) Spectra Mass Spec (NIST) Not Available Spectra Spectrum Singarajah C, Carlson RW. A review of the role of blood lactate measurements in the ICU. J Intensive Care Med. 1998;13(5):218–28. In a dose-ranging study in ESRD patients undergoing hemodialysis, patients received 10, 20, or 40 mg/kg CARNITOR ® 3 times per week following dialysis (N~30 for each dose group). Mean ± SD trough levocarnitine concentrations (μmol/L) by dose after 12 and 24 weeks of therapy are summarized in the table.
Tamai I, Ohashi R, Nezu JI, Sai Y, Kobayashi D, Oku A, Shimane M, Tsuji A: Molecular and functional characterization of organic cation/carnitine transporter family in mice. J Biol Chem. 2000 Dec 22;275(51):40064-72. [ Article] The therapeutic efficacy of Acenocoumarol can be increased when used in combination with Levocarnitine. L-Carnitine is a very small molecule that enables free fatty acids to be transported into the mitochondria of cells to turn into energy. Without the activity of L-Carnitine, fatty bodies would tend to accumulate in muscle tissue, fat tissue and arteries. L-Carnitine can be supplied as a dietary supplement in cases of L-Carnitine deficiency, extra energy intake, as an additional stimulus to fat metabolism, muscular atrophy, fatigue and tiredness, reduced sperm activity, infertility, vitality loss and immune system depression.
Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013;3(1):1–8. Brooks, H., Goldberg, L., Holland, R. et al. 1977. Carnitine-induced effects on cardiac and peripheral hemodynamics. J. Clin. Pharmacol. 17:561-568. The recommended dose is 50 mg/kg given as a slow 2-3 minute bolus injection or by infusion. Often a loading dose is given in patients with severe metabolic crisis, followed by an equivalent dose over the following 24 hours. It should be administered q3h or q4h, and never less than q6h either by infusion or by intravenous injection. All subsequent daily doses are recommended to be in the range of 50 mg/kg or as therapy may require. The highest dose administered has been 300 mg/kg. The table below lists the adverse events that have been reported in two double-blind, placebo-controlled trials in patients on chronic hemodialysis. Events occurring at ≥5% are reported without regard to causality.
Contraindications
Levocarnitine (1 g/700mL) + Acetylcysteine (0.27 g/700mL) + Alanine (3.1 g/700mL) + Arginine (4.1 g/700mL) + Dextrose, unspecified form (60 g/700mL) + Fish oil (3 g/700mL) + Glycine (2.65 g) + Glycyltyrosine (1.58 g/700mL) + Histidine (4.9 g) + Isoleucine (2.9 g/700mL) + Leucine (6.4 g/700mL) + Lysine acetate (8.46 g/700mL) + Medium-chain triglycerides (6 g/700mL) + Methionine (1 g/700mL) + Olive oil (5 g/700mL) + Phenylalanine (1.75 g/700mL) + Proline (1.5 g/700mL) + Serine (3.8 g) + Soybean oil (6 g) + Threonine (4.1 g/700mL) + Tryptophan (1.5 g/700mL) + Tyrosine (0.3 g/700mL) + Valine (4.35 g/700mL) It is advisable to monitor therapy by measuring free and acyl carnitine levels in both plasma and urine. ALT and AST were significantly reduced in our study at day 7 in the intervention group but were only significant between the groups for ALT. Because of tissue damage, ALT and AST increased, and, typically, ALT will be raised to a greater extent than AST [ 25]. Concordant with our results, a randomized clinical trial that evaluated the effects of 750 mg l-carnitine 3 times per day or placebo, in 60 type 2 diabetic patients with nonalcoholic fatty liver disease (NAFLD), reported that ALT and AST declined significantly in the intervention vs. the control group [ 26]. In another study, 2000 mg/day l-carnitine supplementation in 74 participants with nonalcoholic steatohepatitis (NASH), for 6 months, yielded a reduction in ALT and AST in the intervention group at study cessation [ 27]. Interestingly, a systematic review and meta-analysis of 19 randomized trials reported a reduction of ALT and AST following l-carnitine supplementation. Moreover, in the ensuant subgroup analysis, the authors showed that l-carnitine supplementation had a significant and beneficial effect on ALT and AST, only at dosages ≥2 g/day, whilst treatment periods less than 12 weeks or more than 12 weeks were both meaningful [ 28]. It is plausible that a reduction in inflammatory biomarkers and hepatic fibrogenesis may have contributed to a reduction in ALT and AST. Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Studies in dairy cows indicate that the concentration of levocarnitine in milk is increased following exogenous administration of levocarnitine. In nursing mothers receiving levocarnitine, any risks to the child of excess carnitine intake need to be weighed against the benefits of levocarnitine supplementation to the mother. Consideration may be given to discontinuation of nursing or of levocarnitine treatment. Pediatric Use
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