Rapid Administration of Carnitine in sEpsis

Inclusion Criteria:

1. Suspected or confirmed infection (examples include but are not limited to: white cells
in a normally sterile body fluid; perforated viscus; radiographic evidence of
pneumonia in clinical symptoms; a syndrome associated with a high risk of infection
e.g. cellulitis, cutaneous abscess, ascending cholangitis, toxic shock syndrome, fever
of unknown origin with high suspicion of infectious etiology)

2. Any two of four criteria of systemic inflammatory response as defined by the 2001
ACCP/SCCM Consensus Conference Committee;

3. Recognition of septic shock and initiation of quantitative resuscitation within 24
hours of enrollment;

4. Requirement of high dose vasopressors for ≥4 hours to treat shock: Norepinephrine >
0.05mcg/kg/min; dopamine >10mcg/kg/min; Phenylephrine >0.4 mcg/kg/min; epinephrine >
0.05 mcg/kg/min;

5. Cumulative sequential organ failure assessment (SOFA) score of ≥ 6;

6. Blood lactate level of >2.0 mMol/L.

Exclusion Criteria:

1. Age <18 years;

2. Pregnancy or breastfeeding;

3. Any primary diagnosis other than sepsis;

4. Established Do Not Resuscitate status or advanced directives restricting aggressive
care or treating physician deems aggressive care unsuitable;

5. Any history of seizures or a known seizure disorder;

6. Any known inborn error of metabolism;

7. Anticipated requirement for surgery that would interfere with the 12 hour infusion
time;

8. Active participation in another interventional study;

9. Cardiopulmonary resuscitation (chest compression or defibrillation) prior to
enrollment;

10. Known systemic allergy to L-carnitine.

11. Severe immunocompromised state (e.g. subject has neutropenia [receiving cytotoxic
chemotherapy with absolute neutrophil count <500/uL or expected to decline to < 500 uL
within the next three days).

12. Active Treatment with Coumadin