Science review: carnitine in the treatment of valproic acid-induced toxicity - what is the evidence?

Abstract:

:Valproic acid (VPA) is a broad-spectrum antiepileptic drug and is usually well tolerated, but rare serious complications may occur in some patients receiving VPA chronically, including haemorrhagic pancreatitis, bone marrow suppression, VPA-induced hepatotoxicity (VHT) and VPA-induced hyperammonaemic encephalopathy (VHE). Some data suggest that VHT and VHE may be promoted by carnitine deficiency. Acute VPA intoxication also occurs as a consequence of intentional or accidental overdose and its incidence is increasing, because of use of VPA in psychiatric disorders. Although it usually results in mild central nervous system depression, serious toxicity and even fatal cases have been reported. Several studies or isolated clinical observations have suggested the potential value of oral L-carnitine in reversing carnitine deficiency or preventing its development as well as some adverse effects due to VPA. Carnitine supplementation during VPA therapy in high-risk patients is now recommended by some scientific committees and textbooks, especially paediatricians. L-carnitine therapy could also be valuable in those patients who develop VHT or VHE. A few isolated observations also suggest that L-carnitine may be useful in patients with coma or in preventing hepatic dysfunction after acute VPA overdose. However, these issues deserve further investigation in controlled, randomized and probably multicentre trials to evaluate the clinical value and the appropriate dosage of L-carnitine in each of these conditions.

journal_name

Crit Care

authors

Lheureux PE,Penaloza A,Zahir S,Gris M

doi

10.1186/cc3742

keywords:

subject

Has Abstract

pub_date

2005-10-05 00:00:00

pages

431-40

issue

5

eissn

1364-8535

issn

1466-609X

pii

cc3742

journal_volume

9

pub_type

杂志文章,评审
  • Imposed work of breathing during high-frequency oscillatory ventilation: a bench study.

    abstract:INTRODUCTION:The ventilator and the endotracheal tube impose additional workload in mechanically ventilated patients breathing spontaneously. The total work of breathing (WOB) includes elastic and resistive work. In a bench test we assessed the imposed WOB using 3100 A/3100 B SensorMedics high-frequency oscillatory ven...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc3988

    authors: van Heerde M,van Genderingen HR,Leenhoven T,Roubik K,Plötz FB,Markhorst DG

    更新日期:2006-02-01 00:00:00

  • Biological markers of lung injury before and after the institution of positive pressure ventilation in patients with acute lung injury.

    abstract:BACKGROUND:Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute lung injury (ALI). The low tidal volume lung-protective ventilation strategy is associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc5037

    authors: Cepkova M,Brady S,Sapru A,Matthay MA,Church G

    更新日期:2006-01-01 00:00:00

  • Thromboelastometry and organ failure in trauma patients: a prospective cohort study.

    abstract:INTRODUCTION:Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagu...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,多中心研究

    doi:10.1186/s13054-014-0687-6

    authors: Müller MC,Balvers K,Binnekade JM,Curry N,Stanworth S,Gaarder C,Kolstadbraaten KM,Rourke C,Brohi K,Goslings JC,Juffermans NP

    更新日期:2014-12-25 00:00:00

  • The gray zone of the qualitative assessment of respiratory changes in inferior vena cava diameter in ICU patients.

    abstract:INTRODUCTION:Transthoracic echocardiography (TTE) is a useful tool for minimally invasive hemodynamic monitoring in the ICU. Dynamic indices (such as the inferior vena cava distensibility index (dIVC)) can be used to predict fluid responsiveness in mechanically ventilated patients. Although quantitative use of the dIVC...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc13693

    authors: Duwat A,Zogheib E,Guinot P,Levy F,Trojette F,Diouf M,Slama M,Dupont H

    更新日期:2014-01-14 00:00:00

  • Endotoxemia and mortality prediction in ICU and other settings: underlying risk and co-detection of gram negative bacteremia are confounders.

    abstract:INTRODUCTION:The interdependence between endotoxemia, gram negative (GN) bacteremia and mortality has been extensively studied. Underlying patient risk and GN bacteremia types are possible confounders of the relationship. METHODS:Published studies with ≥ 10 patients in either ICU or non-ICU settings, endotoxemia detec...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc11462

    authors: Hurley JC,Guidet B,Offenstadt G,Maury E

    更新日期:2012-08-07 00:00:00

  • The continuum of critical care.

    abstract::Until relatively recently, critical illness was considered as a separate entity and the intensive care unit (ICU), often a little cut-off from other areas of the hospital, was in many cases used as a last resort for patients so severely ill that it was no longer possible to care for them on the general ward. However, ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-019-2393-x

    authors: Vincent JL

    更新日期:2019-06-14 00:00:00

  • Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

    abstract::COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 co...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-020-03369-5

    authors: Hussain A,Via G,Melniker L,Goffi A,Tavazzi G,Neri L,Villen T,Hoppmann R,Mojoli F,Noble V,Zieleskiewicz L,Blanco P,Ma IWY,Wahab MA,Alsaawi A,Al Salamah M,Balik M,Barca D,Bendjelid K,Bouhemad B,Bravo-Figueroa P,Br

    更新日期:2020-12-24 00:00:00

  • Searching for an ideal hemodynamic marker to predict short-term outcome in cardiogenic shock.

    abstract::Cardiogenic shock is a lethal condition. Physicians are searching for hemodynamic markers which could help risk-stratification of patients in this picture. Torgersen and coworkers present an hourly time integral of the cardiac power index and cardiac index drops to predict outcomes in the setting of cardiogenic shock....

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章

    doi:10.1186/cc8176

    authors: Yilmaz MB,Mebazaa A

    更新日期:2009-01-01 00:00:00

  • Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study.

    abstract:BACKGROUND:The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic sh...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,多中心研究

    doi:10.1186/s13054-016-1537-5

    authors: Contou D,Roux D,Jochmans S,Coudroy R,Guérot E,Grimaldi D,Ricome S,Maury E,Plantefève G,Mayaux J,Mekontso Dessap A,Brun-Buisson C,de Prost N

    更新日期:2016-11-06 00:00:00

  • Therapeutic Potential of the Gut Microbiota in the Management of Sepsis.

    abstract::This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-020-2780-3

    authors: Bassetti M,Bandera A,Gori A

    更新日期:2020-03-24 00:00:00

  • Case mix, outcome, and activity for admissions to UK critical care units with severe acute pancreatitis: a secondary analysis of the ICNARC Case Mix Programme Database.

    abstract:INTRODUCTION:Severe acute pancreatitis (SAP) requiring admission to a critical care unit is associated with high mortality and long lengths of stay. We describe the case mix, outcome, and activity of admissions with SAP who were identified from a high-quality clinical database. METHODS:We conducted a secondary analysi...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc5682

    authors: Harrison DA,D'Amico G,Singer M

    更新日期:2007-01-01 00:00:00

  • Use of noninvasive ventilation in immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis.

    abstract:BACKGROUND:Acute respiratory failure (ARF) remains a common hazardous complication in immunocompromised patients and is associated with increased mortality rates when endotracheal intubation is needed. We aimed to evaluate the effect of early noninvasive ventilation (NIV) compared with oxygen therapy alone in this pati...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1186/s13054-016-1586-9

    authors: Huang HB,Xu B,Liu GY,Lin JD,Du B

    更新日期:2017-01-07 00:00:00

  • Risk factors for candidemia: a prospective matched case-control study.

    abstract:BACKGROUND:Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, bot...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-020-2766-1

    authors: Poissy J,Damonti L,Bignon A,Khanna N,Von Kietzell M,Boggian K,Neofytos D,Vuotto F,Coiteux V,Artru F,Zimmerli S,Pagani JL,Calandra T,Sendid B,Poulain D,van Delden C,Lamoth F,Marchetti O,Bochud PY,FUNGINOS.,Allfun F

    更新日期:2020-03-18 00:00:00

  • Risk management in patients with severe acute pancreatitis.

    abstract::Primary or secondary infection of necrotized areas by enteral bacteria is considered a primary cause of mortality in patients with severe acute pancreatitis (SAP). Indeed, 20-30% of patients die during the course of the disease from multiple organ dysfunction after infection. This is why strategies such as antibiotic ...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章

    doi:10.1186/cc3007

    authors: Gerlach H

    更新日期:2004-12-01 00:00:00

  • Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients.

    abstract:BACKGROUND:In patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weakness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity. METHODS:Prospective observational study in critically ill patients. Diaphragm electr...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-020-03435-y

    authors: Sklar MC,Madotto F,Jonkman A,Rauseo M,Soliman I,Damiani LF,Telias I,Dubo S,Chen L,Rittayamai N,Chen GQ,Goligher EC,Dres M,Coudroy R,Pham T,Artigas RM,Friedrich JO,Sinderby C,Heunks L,Brochard L

    更新日期:2021-01-11 00:00:00

  • Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients.

    abstract:INTRODUCTION:Delirium occurs in most ventilated patients and is independently associated with more deaths, longer stay, and higher cost. Guidelines recommend monitoring of delirium in all intensive care unit (ICU) patients, though few data exist in non-ventilated patients. The study objective was to determine the relat...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc3729

    authors: Thomason JW,Shintani A,Peterson JF,Pun BT,Jackson JC,Ely EW

    更新日期:2005-08-01 00:00:00

  • The dynamic pattern of end-tidal carbon dioxide during cardiopulmonary resuscitation: difference between asphyxial cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest.

    abstract:INTRODUCTION:Partial pressure of end-tidal carbon dioxide (PetCO2) during cardiopulmonary resuscitation (CPR) correlates with cardiac output and consequently has a prognostic value in CPR. In our previous study we confirmed that initial PetCO2 value was significantly higher in asphyxial arrest than in ventricular fibri...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc9417

    authors: Lah K,Križmarić M,Grmec S

    更新日期:2011-01-01 00:00:00

  • Dexmedetomidine sedation reduces atrial fibrillation after cardiac surgery compared to propofol: a randomized controlled trial.

    abstract:BACKGROUND:Atrial fibrillation occurs frequently in patients following cardiac surgery and can be a cause of increased morbidity and mortality. The use of dexmedetomidine to prevent atrial fibrillation is unclear. The present study was designed to evaluate the effect of dexmedetomidine sedation on the incidence of atri...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-016-1480-5

    authors: Liu X,Zhang K,Wang W,Xie G,Fang X

    更新日期:2016-09-21 00:00:00

  • Procalcitonin as a marker of bacterial infection in the emergency department: an observational study.

    abstract:INTRODUCTION:Procalcitonin (PCT) has been proposed as a marker of infection in critically ill patients; its level is related to the severity of infection. We evaluated the value of PCT as a marker of bacterial infection for emergency department patients. METHODS:This prospective observational study consecutively enrol...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc2396

    authors: Chan YL,Tseng CP,Tsay PK,Chang SS,Chiu TF,Chen JC

    更新日期:2004-02-01 00:00:00

  • Whole blood thromboelastometry: another Knight at the Roundtable?

    abstract::Thromboelastography and thromboelastometry represent viscoelastic diagnostic methodologies with promising application to diseases of altered coagulation. Their use in trauma-induced coagulopathy as a means of assessing the real-time status of the patient's functional coagulation profile in addition to its impact on ef...

    journal_title:Critical care (London, England)

    pub_type: 评论,社论

    doi:10.1186/cc10569

    authors: Bluth MH,Kashuk JL

    更新日期:2011-01-01 00:00:00

  • During critical illness the gut does not pass the acid test.

    abstract::The composition and function of intestinal microflora are emerging as integral to both health and disease. During critical illness the normal microbiota are rapidly replaced by pathogenic species as a result of both the physiologic stress itself and the use of antibiotics. In this report, the authors use fecal pH as a...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章

    doi:10.1186/cc11474

    authors: Alverdy JC

    更新日期:2012-09-12 00:00:00

  • The incretin effect in critically ill patients: a case-control study.

    abstract:INTRODUCTION:Patients admitted to the intensive care unit often develop hyperglycaemia, but the underlying mechanisms have not been fully described. The incretin effect is reduced in patients with type 2 diabetes. Type 2 diabetes and critical illness have phenotypical similarities, such as hyperglycaemia, insulin resis...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-015-1118-z

    authors: Nielsen ST,Janum S,Krogh-Madsen R,Solomon TP,Møller K

    更新日期:2015-11-16 00:00:00

  • Cardiovascular response to dobutamine stress predicts outcome in severe sepsis and septic shock.

    abstract:INTRODUCTION:During septic shock, resistance to the haemodynamic effects of catecholamine vasopressors and inotropes is a well-recognised marker of mortality risk. However, the specific cardiovascular or metabolic response elements that are most closely associated with outcome have not been well defined. The objective ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc6814

    authors: Kumar A,Schupp E,Bunnell E,Ali A,Milcarek B,Parrillo JE

    更新日期:2008-01-01 00:00:00

  • Venous oxygen measurements in the inferior vena cava in neonates with respiratory failure.

    abstract::BACKGROUND: The present study was undertaken to examine the feasibility of venous oxygen measurements in the inferior vena cava (IVC) via a catheter through the umbilical vein. This may serve as a proxy for mixed venous oxygenation and the complications of right atrial cannulation can be avoided at the same time. It h...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc126

    authors: Plötz FB,van Lingen RA,Bos AP

    更新日期:1998-01-01 00:00:00

  • Left ventricular function: time-varying elastance and left ventricular aortic coupling.

    abstract::Many aspects of left ventricular function are explained by considering ventricular pressure-volume characteristics. Contractility is best measured by the slope, Emax, of the end-systolic pressure-volume relationship. Ventricular systole is usefully characterized by a time-varying elastance (ΔP/ΔV). An extended area, t...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-016-1439-6

    authors: Walley KR

    更新日期:2016-09-10 00:00:00

  • Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients with COVID-19 from Wuhan, China.

    abstract:BACKGROUND:Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease and rapidly escalating epidemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pathogenesis of COVID-19 remains to be elucidated. We aimed to clarify correlation of systemic inflammation with disease s...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-020-03255-0

    authors: Zeng Z,Yu H,Chen H,Qi W,Chen L,Chen G,Yan W,Chen T,Ning Q,Han M,Wu D

    更新日期:2020-08-27 00:00:00

  • Augmented renal clearance in septic and traumatized patients with normal plasma creatinine concentrations: identifying at-risk patients.

    abstract:INTRODUCTION:Improved methods to optimize drug dosing in the critically ill are urgently needed. Traditional prescribing culture involves recognition of factors that mandate dose reduction (such as renal impairment), although optimizing drug exposure, through more frequent or augmented dosing, represents an evolving st...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc12544

    authors: Udy AA,Roberts JA,Shorr AF,Boots RJ,Lipman J

    更新日期:2013-02-28 00:00:00

  • Glycaemic control targets after traumatic brain injury: a systematic review and meta-analysis.

    abstract:BACKGROUND:Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU). METHODS:We systematically se...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1186/s13054-017-1883-y

    authors: Hermanides J,Plummer MP,Finnis M,Deane AM,Coles JP,Menon DK

    更新日期:2018-01-19 00:00:00

  • Medical emergencies on board commercial airlines: is documentation as expected?

    abstract:INTRODUCTION:The purpose of this study was to perform a descriptive, content-based analysis on the different forms of documentation for in-flight medical emergencies that are currently provided in the emergency medical kits on board commercial airlines. METHODS:Passenger airlines in the World Airline Directory were co...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc11238

    authors: Sand M,Morrosch S,Sand D,Altmeyer P,Bechara FG

    更新日期:2012-12-12 00:00:00

  • Dosing adjuvant vitamin C in critically ill patients undergoing continuous renal replacement therapy: We are not there yet!

    abstract:: ...

    journal_title:Critical care (London, England)

    pub_type: 评论,信件

    doi:10.1186/s13054-018-2297-1

    authors: Honore PM,De Bels D,Kugener L,Redant S,Attou R,Gallerani A,Spapen HD

    更新日期:2019-01-09 00:00:00