ACQUIRED CARNITINE ABNORMALITIES IN CRITICALLY ILL CHILDREN

In order to characterize the role of carnitine during metabolic stress , we prospectively determined carnitine profiles in plasma and urine o n admission, days 2, 5, 10 and 15, among 28 critically ill children fr ee of any known conditions associated with secondary carnitine deficie ncy. More than 25% of plasma and 50% of urinary carnitine measurements were abnormal; 96% (27/28) of patients displayed on at least one occa sion an abnormal [<-2 SD or >+2 SD] carnitine value in plasma. Three c hildren had extremely low [<10 mu mol/l] free carnitine (FC) levels in plasma. Plasma esterified and FC levels on admission were not related to the risk of mortality [PRISM score], to muscle lysis [CK values], and to the caloric intake. Levels of FC and esterified carnitine in pl asma were unrelated to those measured in urine. Conclusion Abnormal pl asma and urine carnitine measurements are frequently found in critical ly ill children. the biological significance of these perturbations re mains unclear. Caution must be exercised before concluding that an abn ormal carnitine value is indicative of an underlying hereditary metabo lic disorder in this population.