title: Evaluation of serum carnitine levels for pediatric patients receiving carnitine-free and carnitine-supplemented parenteral nutrition.
abstract: OBJECTIVE
  Carnitine is a carrier molecule transporting long-chain fatty acids (LCFAs) into the mitochondria for fatty acid β-oxidation. The purpose of this study is to evaluate the role of carnitine supplementation in parenteral nutrition (PN) within the pediatric population. Our goal was to determine a weight range for which empiric carnitine supplementation is justified and to determine a weight range at which a carnitine level should first be drawn to confirm a deficiency prior to supplementation. Secondarily, we tried to determine a relationship among carnitine deficiency, hypoglycemia, and hypertriglyceridemia.
  
  
  METHODS
  This was a retrospective observational study to evaluate 2 groups of pediatric patients (weighing 0.68 kg to 60 kg) who were NPO and receiving PN. The first group of patients (n = 454) received carnitine supplementation (15 mg/kg/day) upon initiation of PN. The second group (n = 299) did not receive carnitine supplementation until they were determined to have a carnitine deficiency.
  
  
  RESULTS
  The data indicated that 82% of the patients weighing less than 5 kg were deficient. Patients weighing more than 5 kg had serum carnitine levels within the normal range. Therefore, patients receiving PN and weighing less than 5 kg should be supplemented with carnitine. Comparison of triglyceride, glucose, and carnitine showed no statistically significant difference (P = .1936).
  
  
  CONCLUSIONS
  Patients weighing more than 5 kg should have serum carnitine levels drawn within 7 days to determine whether supplementation is needed. There is no statistical correlation among carnitine deficiency, hypoglycemia, and hypertriglyceridemia.
authors: Department of Pharmacy, Primary Children's Hospital , Salt Lake City, Utah.
authors: Brian
authors: B
authors: Winther
authors: Department of Gastroenterology, Primary Children's Hospital, and University of Utah School of Medicine , Salt Lake City, Utah.
authors: Daniel
authors: D
authors: Jackson
authors: Nutrition Support, Primary Children's Hospital , Salt Lake City, Utah .
authors: Cecilia
authors: C
authors: Mulroy
authors: Department of Pharmacy, Primary Children's Hospital , Salt Lake City, Utah.
authors: Mark
authors: M
authors: MacKay
keywords: TPN; carnitine supplementation; infants; neonates; parenteral nutrition