Skip to main content
Log in

Systemic carnitine deficiency: Benefit of oral carnitine supplements vs. persisting biochemical abnormalities

  • Case Reports
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

A patient is described who was admitted with a condition similar to the Reye syndrome at the age of 9 months. Hypoglycemia, hyperammonemia, hepatomegaly, and lethargy were present. The plasma concentrations of free and acylcarnitine were extremely low and the urine contained excessive amounts of dicarboxylic acids. Extensive biochemical and histological investigations of biopsied liver and muscle led to the diagnosis of systemic carnitine deficiency. The patient was put on oral carnitine treatment, upon which he remained clinically well. A prolonged fasting test during this treatment gave abnormal results: there was no ketonemia, but an increase of ω-oxidation of fatty acids. In spite of the treatment the liver and muscle carnitine content remained below normal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Angelini C, Philippart M, Borrone C, Bresolin N, Cantini M, Luck S (1980) Multisystem triglyceride storage disorder with impaired long-chain fatty acid oxidation. Ann Neurol 7:5–10

    Google Scholar 

  2. Bougnères PF, Saudubray JM, Marsac C, Bernard O, Odievre M, Girard J (1981) Fasting hypoglycemia resulting from hepatic carnitine palmitoyl transferase deficiency. J Pediatr 98:742–746

    Google Scholar 

  3. Chapoy PR, Angelini C, Brown WJ, Stiff JE, Shug AL, Cederbaum SD (1980) Systemic carnitine deficiency. A treatable inherited lipid-storage disease presenting as Reye's syndrome. N Engl J Med 303: 1389–1394

    Google Scholar 

  4. Cornelio F, Di Donato S, Peluchetti D, Bizzi A, Bertagnolio B, D'Angelo A, Wiesmann U (1977) Fatal cases of lipid storage myopathy with carnitine deficiency. J Neurol Neurosurg Psychiatry 40:170–178

    Google Scholar 

  5. Engel AG, Banker BQ, Eiben RM (1977) Carnitine deficiency: clinical, morphological, and biochemical observations in a fatal case. J Neurol Neurosurg Psychiatry 40:313–322

    Google Scholar 

  6. Genuth SM, Hoppel CL (1979) Plasma and urinary carnitine in diabetic ketosis. Diabetes 28:1083–1087

    Google Scholar 

  7. Glasgow AM, Eng G, Engel AG (1980) Systemic carnitine deficiency simulating recurrent Reye syndrome. J Pediatr 96: 889–891

    Google Scholar 

  8. Gregersen N, Wintzensen H, Kølvraa S, Christensen E, Christensen MF, Brandt NJ, Rasmussen K (1982) C6-C10-Dicarboxylic aciduria: investigations of a patient with riboflavin responsive multiple acyl-CoA dehydrogenation defects. Pediatr Res 16:861–868

    Google Scholar 

  9. Hoppel CL, Genuth SM (1980) Carnitine metabolism in normal-weight and obese human subjects during fasting. Am J Physiol 238:E409-E415

    Google Scholar 

  10. Kamerling JP, Brouwer M, Ketting D, Wadman SK (1979) Gas chromatography of urinary N-phenylacetylglutamine. J Chromatogr 164:217–221

    Google Scholar 

  11. Karpati G, Carpenter S, Engel AG, Watters G, Allen J, Rothman S, Klassen G, Mamer OA (1975) The syndrome of systemic carnitine deficiency. Neurology 25:16–24

    Google Scholar 

  12. Mamer OA, Montgomery JA, Colle E (1980) Profiles in altered metabolism III. (Ω-1)-hydroxyacid excretion in a case of episodic hypoglycemia. Biomed Mass Spectrom 7:53–57

    Google Scholar 

  13. Mortensen PB, Gregersen N (1980) Medium-chain triglyceride medication as a pitfall in the diagnosis of non-ketotic C6-C10-dicarboxylic acidurias. Clin Chim Acta 103:33–37

    Google Scholar 

  14. Mortensen PB, Gregersen N (1981) The biological origin of ketotic dicarboxylic aciduria. In vivo and in vitro investigations of the ω-oxidation of C6-C10-monocarboxylic acids in unstarved, starved and diabetic rats. Biochim Biophys Acta 666:394–404

    Google Scholar 

  15. Mortensen PB, Gregersen N, Rasmussen K, Kølvraa S (1983) The β-oxidation of dicarboxylic acids in isolated mitochondria and peroxisomes. J Inherited Metab Dis 6 [suppl] 2:123–124

    Google Scholar 

  16. Niederwieser A, Steinmann B, Exner U, Neuheiser F, Redweik U, Wang M, Rampini S, Wendel U (1983) Multiple acyl-CoA dehydrogenation deficiency in a boy with nonketotic hypoglycemia, hepatomegaly, muscle hypotonia and cardiomyopathy. Helv Paediatr Acta 38:9–26

    Google Scholar 

  17. Pearson DJ, Tubbs PK, Chase JFA (1969) Carnitine and acylcarnitines. Methods Enzymol 14:1758–1771

    Google Scholar 

  18. Saudubray JM, Marsac C, Limal JM, Dumurgier E, Charpentier C, Ogier H, Coude FX (1981) Variation in plasma ketone bodies during a 24-hour fast in normal and in hypoglycemic children: relationship to age. J Pediatr 98:904–908

    Google Scholar 

  19. Scholte HR, Meyer AEFH, van Wijngaarden GK, Leenders KL (1979) Familial carnitine deficiency. A fatal case and subclinical state in a sister. J Neurol Sci 42:87–101

    Google Scholar 

  20. Scholte HR, Busch HFM, Barth PG, Beekman RP, Duran M, Przyrembel H, Roth B, Luyt-Houwen IEM (1983) Carnitine deficiency and respiratory chain blockade In: Scarlata G, Cerri C (eds) Mitochondrial Pathology in Muscle Diseases. Piccin Med Books, Padua, pp 215–228

    Google Scholar 

  21. Schutgens RBH, Heymans H, Ketel A, Veder HA, Duran M, Ketting D, Wadman SK (1979) Lethal hypoglycemia in a child with a deficiency of 3-hydroxy-3-methylglutaryl-coenzyme A lyase. J Pediatr 94: 89–91

    Google Scholar 

  22. Stanley CA, Baker L (1976) Hyperinsulinism in infancy: diagnosis by demonstration of abnormal response to fasting hypoglycemia. Pediatrics 57:702–711

    Google Scholar 

  23. Teijema HL, van Gelderen HH, Giesberts MAH (1980) Hypoketosis as a cause of symptoms in childhood hypoglycemia. Eur J Pediatr 134:51–55

    Google Scholar 

  24. Tripp ME, Katcher ML, Peters HA, Gilbert EF, Arya S, Hodach RJ, Shug AL (1981) Sysmtemic carnitine deficiency presenting as familial endocardial fibroelastosis. A treatable cardiomyopathy. N Engl J Med 305:385–390

    Google Scholar 

  25. Van Hinsberg VWM, Veerkamp JH, van Moerkerk HTB (1978) An accurate and sensitive assay of long-chain fatty acid oxidation in human skeletal muscle. Biochem Med 20:256–266

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Duran, M., de Klerk, J.B.C., Wadman, S.K. et al. Systemic carnitine deficiency: Benefit of oral carnitine supplements vs. persisting biochemical abnormalities. Eur J Pediatr 142, 224–228 (1984). https://doi.org/10.1007/BF00442456

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00442456

Key words

Navigation