Carnitine deficiency in chronic critical illness.

Détails

ID Serval
serval:BIB_BA2EC3243BDB
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Carnitine deficiency in chronic critical illness.
Périodique
Current Opinion in Clinical Nutrition and Metabolic Care
Auteur(s)
Bonafé L., Berger M.M., Que Y.A., Mechanick J.I.
ISSN
1473-6519 (Electronic)
ISSN-L
1363-1950
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
17
Numéro
2
Pages
200-209
Langue
anglais
Notes
Publication types: Journal Article Document Type: Review , pdf : REVIEW
Résumé
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.
Pubmed
Web of science
Création de la notice
04/05/2014 8:53
Dernière modification de la notice
20/08/2019 15:28
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