Hypocarnitinemic Hypoglycemia and Heart Failure in an Infant with a Constant Parenteral Elementary Nutrition during Measles Vaccination-Related Febrile Illness

Abstract

A 1-year and 11-month-old female infant with bilateral lesions of the thalamus, basal ganglia, cerebellar and brainstem disease died from heart failure 9 days after being administered a measles vaccination. She had a high fever, hypocarnitinemic and non-ketotic hypoglycemia, serum levels of total carnitine 7.4 μmol/L, free carnitine 5.6 μmol/L, acylcarnitine 1.8 μmol/L and glucose 13 mg/dL. Due to feeding difficulty, the patient, however, had been administered parenteral elementary nutrition through a feeding tube since early infancy. The commercially available parenteral nutrition solutions do not contain carnitine. A secondary carnitine deficiency followed by non-ketotic hypoglycemia-related heart failure may readily develop even in a patient without valproic acid, during high fever.

Key words

Carnitine - measles vaccination - severe motor and intellectual disabilities - hypocarnitinemia - parenteral elementary nutrition

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