title: L-carnitine increases survival in a murine model of severe verapamil toxicity.
abstract: OBJECTIVE
  L-carnitine is an essential compound involved in cellular energy production through free fatty acid metabolism. It has been theorized that severe verapamil toxicity "shifts" heart energy production away from free fatty acids and toward other sources, contributing to profound cardiogenic shock. The primary study objective was to determine whether intravenous (IV) L-carnitine affects survival in severe verapamil toxicity. Secondary objectives were to determine the effects on hemodynamic parameters. The authors hypothesized that IV L-carnitine would increase both survival and hemodynamic parameters in severe verapamil toxicity.
  
  
  METHODS
  This was a controlled, blinded animal investigation. Sixteen male rats were anesthetized, ventilated, and instrumented to record mean arterial pressure (MAP) and heart rate. Verapamil toxicity was achieved by a constant infusion of 5 mg/kg/hr. After 5 minutes a bolus of 50 mg/kg of either L-carnitine or normal saline was given. The experiment concluded when either 10% of baseline MAP was achieved or 150 minutes had elapsed. The data were analyzed using Kaplan-Meier analysis, log rank test, and analysis of variance.
  
  
  RESULTS
  The median survival for the animals in the L-carnitine group was 140.75 minutes (interquartile range [IQR] = 98.6 to 150 minutes), and for those in the normal saline group it was 49.19 minutes (IQR = 39.02 to 70.97 minutes; p = 0.0001). At 15 minutes the MAP was 20.45 mm Hg greater in the animals in the L-carnitine group than in the animals in the normal saline group (95% confidence interval [CI] = 0.25 to 40.65; p = 0.047).
  
  
  CONCLUSIONS
  When compared with saline, IV L-carnitine increases survival and MAP in a murine model of severe verapamil toxicity.
authors.affiliation: Department of Emergency Medicine, St Luke's/Roosevelt Hospital, New York, NY, USA. eperez95@yahoo.com
authors.forename: Eric
authors.initials: E
authors.lastname: Perez
authors.forename: Jason
authors.initials: J
authors.lastname: Chu
authors.forename: Theodore
authors.initials: T
authors.lastname: Bania
authors.forename: Kamal
authors.initials: K
authors.lastname: Medlej
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000633:toxicity*; D002331:Carnitine; D004195:Disease Models, Animal; D007262:Infusions, Intravenous; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D012770:Shock, Cardiogenic / Q000139:chemically induced; D014700:Verapamil / Q000008:administration & dosage / Q000633:toxicity*
chemical_list: D002121:Calcium Channel Blockers; D014700:Verapamil; D002331:Carnitine