Abstract
Objectives
The aim of this study is to determine the plasma free carnitine and acyl-carnitine levels at the time of diabetic ketoacidosis (DKA) diagnosis, and at the end of DKA treatment and to investigate their association with the duration of DKA treatment in children with DKA.
Methods
A total of 40 children with DKA who were treated consecutively in a tertiary health center for DKA were included in the study. The median age of the children was 11.3 years (1.1–17.5) and 25 of them (62.5%) were girls. In addition to routine blood tests, plasma free carnitine and acyl-carnitine levels were measured just before the start of intravenous insulin therapy and at the time of discontinuation of intravenous insulin therapy when DKA therapy was completed.
Results
There was no difference in plasma free carnitine and acyl-carnitine levels before and after DKA treatment (p=0.776 and p=0.743 respectively). However, while the frequency of low plasma free carnitine was 30% at the beginning of the treatment, it was observed that this frequency was 20% at the end of the DKA treatment. There was no correlation between duration of DKA treatment and plasma free carnitine or acyl-carnitine levels at admission (p=0.497, r=−0.111 and p=0.474, r=0.116 respectively).
Conclusions
There is no a relationship between duration of DKA treatment and plasma free carnitine or acyl-carnitine level at admission in children with DKA.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from the legal guardians of all individuals included in this study.
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Ethical approval: Ethical approval for the study was obtained from the local Ethics Committee.
References
1. Wolfsdorf, JI, Glaser, N, Agus, M, Fritsch, M, Hanas, R, Rewers, A, et al.. ISPAD clinical practice consensus guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes 2018;19:155–77. https://doi.org/10.1111/pedi.12701.Search in Google Scholar PubMed
2. Hoffman, WH, Siedlak, SL, Wang, Y, Castellani, RJ, Smith, MA. Oxidative damage is present in the fatal brain edema of diabetic ketoacidosis. Brain Res 2011;1369:194–202. https://doi.org/10.1016/j.brainres.2010.10.085.Search in Google Scholar PubMed PubMed Central
3. Adeva-Andany, MM, Calvo-Castro, I, Fernandez-Fernandez, C, Donapetry-Garcia, C, Pedre-Pineiro, AM. Significance of l-carnitine for human health. IUBMB Life 2017;69:578–94. https://doi.org/10.1002/iub.1646.Search in Google Scholar PubMed
4. Genuth, SM, Hoppel, CL. Plasma and urine carnitine in diabetic ketosis. Diabetes 1979;28:1083–7. https://doi.org/10.2337/diab.28.12.1083.Search in Google Scholar PubMed
5. Soltesz, G, Melegh, B, Sandor, A. The relationship between carnitine and ketone body levels in diabetic children. Acta Paediatr Scand 1983;72:511–5. https://doi.org/10.1111/j.1651-2227.1983.tb09762.x.Search in Google Scholar PubMed
6. Jahoor, F, Hsu, JW, Mehta, PB, Keene, KR, Gaba, R, Mulukutla, SN, et al.. Metabolomics profiling of patients with A-beta+ ketosis-prone diabetes during diabetic ketoacidosis. Diabetes 2021;70:1898–909. https://doi.org/10.2337/db21-0066.Search in Google Scholar PubMed PubMed Central
7. Hoffman, WH, Whelan, SA, Lee, N. Tryptophan, kynurenine pathway, and diabetic ketoacidosis in type 1 diabetes. PLoS One 2021;16:e0254116. https://doi.org/10.1371/journal.pone.0254116.Search in Google Scholar PubMed PubMed Central
8. Schmidt-Sommerfeld, E, Werner, D, Penn, D. Carnitine plasma concentrations in 353 metabolically healthy children. Eur J Pediatr 1988;147:356–60. https://doi.org/10.1007/bf00496410.Search in Google Scholar PubMed
9. Cederblad, G, Hermansson, G, Ludvigsson, J. Plasma and urine carnitine in children with diabetes mellitus. Clin Chim Acta 1982;125:207–17. https://doi.org/10.1016/0009-8981(82)90197-8.Search in Google Scholar PubMed
10. Winter, SC, Simon, M, Zorn, EM, Szabo-Aczel, S, Vance, WH, O’Hara, T, et al.. Relative carnitine insufficiency in children with type I diabetes mellitus. Am J Dis Child 1989;143:1337–9. https://doi.org/10.1001/archpedi.1989.02150230095030.Search in Google Scholar PubMed
11. Mamoulakis, D, Galanakis, E, Dionyssopoulou, E, Evangeliou, A, Sbyrakis, S. Carnitine deficiency in children and adolescents with type 1 diabetes. J Diabet Complicat 2004;18:271–4. https://doi.org/10.1016/s1056-8727(03)00091-6.Search in Google Scholar
12. Malone, JI, Schocken, DD, Morrison, AD, Gilbert-Barness, E. Diabetic cardiomyopathy and carnitine deficiency. J Diabet Complicat 1999;13:86–90. https://doi.org/10.1016/s1056-8727(99)00039-2.Search in Google Scholar PubMed
13. Negro, P, Gossetti, F, Pinta, ML, Mariani, P, Carboni, M. The effect of L-carnitine, administered through intravenous infusion of glucose, on both glucose and insulin levels in healthy subjects. Drugs Exp Clin Res 1994;20:257–62.Search in Google Scholar
14. Mingrone, G. Carnitine in type 2 diabetes. Ann N Y Acad Sci 2004;1033:99–107. https://doi.org/10.1196/annals.1320.009.Search in Google Scholar PubMed
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