Carnitine and septic shock: a review

Most studies have reported reduced carnitine levels in the tissues of patients with sepsis, probably due to increased urinary excretion. Because of the increased utilization of fatty acids and ketone bodies as sources of energy in sepsis, the carnitine deficiency can further impair the fuel metabolism and contribute to the unregulated lipid metabolism in these patients.Recently, experimental and clinical studies have shown that carnitine and its congeners are able to: (a) downmodulate the spontaneous and endotoxin (LPS)-triggered overproduction of tumor necrosis factor (TNF)-alpha; (b) ameliorate the lipid metabolism; and (c) reduce the severity of illness, accelerate recovery, and, in some cases, improve survival in experimental septic shock.Many questions concerning the ultimate molecular mechanism of action of these compounds in endotoxaemia are still unanswered. Yet, these compounds may be helpful in patients with sepsis, when associated with conventional therapy, in that they can effectively reduce TNF-alpha levels and ameliorate the host's metabolic processes.