Hypocarnitinemic hypoglycemia and heart failure in an infant with a constant parenteral elementary nutrition during measles vaccination-related febrile illness.
A 1-year and 11-month-old female infant with bilateral lesions of the thalamus, basal ganglia, cerebellar and brainstem disease died from heart failure 9 days after being administered a measles vaccination. She had a high fever, hypocarnitinemic and non-ketotic hypoglycemia, serum levels of total carnitine 7.4 micromol/L, free carnitine 5.6 micromol/L, acylcarnitine 1.8 micromol/L and glucose 13 mg/dL. Due to feeding difficulty, the patient, however, had been administered parenteral elementary nutrition through a feeding tube since early infancy. The commercially available parenteral nutrition solutions do not contain carnitine. A secondary carnitine deficiency followed by non-ketotic hypoglycemia-related heart failure may readily develop even in a patient without valproic acid, during high fever.
Okanari
K
K
Department of Brain and Nerve Science, Pediatrics, Oita University Faculty of Medicine, Oita, Yufu, Japan. o-kazuo@med.oita-u.ac.jp
Takahashi
M
M
Maeda
T
T
Sato
K
K
Suenobu
S
S
Izumi
T
T
D002331:Carnitine / Q000172:deficiency*; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007223:Infant; D008279:Magnetic Resonance Imaging; D008458:Measles Vaccine / Q000009:adverse effects*; D010288:Parenteral Nutrition; D003294:Seizures, Febrile / Q000209:etiology*
D008458:Measles Vaccine; D002331:Carnitine