title: L-carnitine administration reverses acute mental status changes in a chronic hemodialysis patient with hepatitis C infection.
abstract: A chronic hemodialysis patient presented with elevated serum ammonia concentration (189 micromol/l) and acutely altered mental status. He had been adequately dialyzed over the prior months and had no evidence of liver dysfunction, despite serological evidence for hepatitis C virus infection. His mental status deteriorated to coma despite vitamin replenishment, intensive hemodialysis, lactulose treatment, and blood pressure control over a 3-day period. Blood free L-carnitine concentration was depressed, and total carnitine concentrations was normal. Three hours after a single 2 g dose of L-carnitine was administered intravenously, the mental status reverted to normal. Hyperammonemia resolved over a 5-week period. We suspect that subclinical liver dysfunction and dialysis status in tandem contributed to the carnitine deficiency, hyperammonemia, and confusion and that the L-carnitine administration reversed these biochemical and clinical abnormalities.
authors.affiliation: Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: DaVanzo
authors.forename: M E
authors.initials: ME
authors.lastname: Ullian
mesh_terms: D002331:Carnitine / Q000097:blood / Q000627:therapeutic use*; D003244:Consciousness Disorders / Q000188:drug therapy* / Q000209:etiology; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D002331:Carnitine