A 3 S T RA C T Carnitine is synthesized from lysine and metlhionine. In the rat, inade(quiate intake of either of these essential amino acids cauises carnitinie depletioIn 14 of' 36 hospitalized cirrhotics hald subnormal valtues for seruim carnitine. The creatinine/height index, midarm munscle circumference, and triceps skin-fold thickness indicated protein-calorie starvation in the 14 hypocarnitinemic liver patients. In six of the hypocarnitinemic cirrhotics (average seruim level 50% of normal), spontaneouis dietary intakes of' carnitine, lysine, and methionine were measuired and foulnd to be only 5-15% as great as in six normocarnitinemiic, healthy controls. When these six cirrhotic anuI six normnal stil)jects were given the same lysine-rich, methioninle-ricl, and carnitine-free nultritionaitl intake, the normaiitls mnain tained n oi-'matl serumiii camr iti ne levels and exeretedl 100 tLmol/day, wvhereas the cirrlhoties' sertum level fell to 25% of noimatl, and(l uirinary excretion dec ined to 15 Lmol/day. Seven lhypocarniitiniemic cirrhotics dlie(l. P'ostmlortemn concentratioons of' carnitine in liver, musele, heart, kidney, and brain averagedl only one-fouirtlh to onethir(d those in corresponding tisstues of eight normally noutrished nonhepatic patients who died after an actute illness of a 1-3-day duiration.These data show that carn-itine depletion is common in pattients hospitalized for advanced cirrhosis, and that it resuilts from three factors: stubstandard intake of dietary carnitine; substandard intake of lysine and methionine, the prectursors ftor endlogenouis carnitine synthesis; acnd loss of' cappacity to syntlhesize carnitine from lysine and methiioniine.

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