A 56-year-old woman with septic shock presented with persistent hyperlactatemia, despite an adequate clinical response to treatment. Carnitine deficiency was suspected, as the patient was malnourished and chronically taking valproic acid. No other plausible cause of hyperlactatemia was found. Carnitine supplementation resulted in rapid normalization of lactatemia.
BonaféLBergerMMQueYA, et al.Carnitine deficiency in chronic critical illness. Curr Opin Clin Nutr Metab Care. 2014;17:200–209.
2.
FlanaganJLSimmonsPAVehigeJ, et al.Role of carnitine in disease. Nutr Metab. 2010;7:30.
3.
LheureuxPEPenalozaAZahirS, et al.Science review: carnitine in the treatment of valproic acid-induced toxicity—what is the evidence?Crit Care. 2005;9:431–440.
4.
PuskarichMAKlineJAKrabillV, et al.Preliminary safety and efficacy of L-carnitine infusion for the treatment of vasopressor-dependent septic shock: a randomized control trial. J Parenter Enteral Nutr. 2014;38:736–743.
5.
RhodesAEvansLEAlhazzaniW, et al.Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552.
6.
AndersenLWMackenhauerJRobertsJC, et al.Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013;88:1127–1140.
7.
DoréMSan JuanAEFrenetteAJ, et al.Clinical importance of monitoring the unbound valproic acid concentration in patients with hypoalbuminemia. Pharmacotherapy. 2017;37(8):900–907. doi:10.1002/phar.1965
