Fig. 1
![(Adapted from [22,23]). Possible mechanisms of amiodarone-induced hypertriglyceridemia and hyperammonemia. Amiodarone is recognized as a potential inhibitor of carnitine-palmityl transferase 1 (CPT1). This will result in a reduced availability of acylcarnitine, with impaired beta-oxidation and acetyl-CoA production. Amiodarone also impairs the mitochondrial respiratory chain activity at the level of complexes I and II. The decrease in acetyl-CoA may also reduce the availability of N-acetyl glutamic acid (NAGA), a substrate for carbamoyl phosphate synthetase (CPS1).](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/64720d53215d2f6c89dba300/j_jccm-2019-0026_fig_001.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA6AP2G7AKBPCYPRE7%2F20260120%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20260120T054154Z&X-Amz-Expires=3600&X-Amz-Security-Token=IQoJb3JpZ2luX2VjENn%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaDGV1LWNlbnRyYWwtMSJIMEYCIQD%2FG6iUQGZGErFp%2FDklL72RXS6KfKaLozed%2B4%2BCD3eVDQIhAJpEqIVDYthriw7%2B9mecIs3jAfdjHFDusWccuhCJ29lTKsYFCKL%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEQAhoMOTYzMTM0Mjg5OTQwIgxF2k%2F23wCv6Khad0oqmgVc8QLejzXB%2Fod9nNgCGRNPkZtAOyF9tH7l9PQT4JJz%2BomOLdFohZSPMxY1FDGT6Y8fFfj7IN%2Ff9yy3yfb7Q7E6VK8jN4VVBvCw03PO30jnik4Of70AOfBHZh6%2BT%2BFZB9Kl8yr0lI%2FUIa4xr59c%2FzmWKPsSz8DmnJlapDtG4wYHFmUIcQ6w8RV86w5IDO9kOaMWI3ooVK6aaBya7fNmWPZdZVsMoBw7fMJrPsy%2F5X%2BN%2BMTk8NP2yogdNCz4bksiXLhmbTXNDZocaUvy4akM6WhH%2FWSdTK7AE%2BMl0ftmq%2FvZmMQa3QY5Ej%2FlWtnEyddnWzqD3LMyIfGBiWgscQjoXV1%2B9f3SAbvr4kUhEgPxLRk61r2eHhKZQkQRRRZu4l3dElcGCd9rpTCIlXRziY6AZFs6%2BHwmRyyUeSauvuXkk8b%2BlPpVhRfV5BHqNnT%2Bw8dWpr3ni1qOzCbBrEMu7gvZiWxuiYlOZNq1DU0EfB6f3TjDfTy8zpeOdeuOTw1LCdViTPRj1uimESuZ1P8Hde6F3DZivpFn2SIAiiQHU7HVdkMrITNKdsgXDwq0BHgHfFP9Xhp2bEF6xb2dGg4V38NdXRY7hWZlnxCaqJgqihTlqqMLL7LcyAqiusuPxOcE%2FWKBVYkUMq9jlJCRKKBsuDTD3mCIMucQYw4DYog3BCHynip4%2F3I7yXM%2FJDUVfFXLjMmxOmeB2ZiGZE9gBnPajR%2BO37voPxMr%2BK9qu2aiILUF3GkyPf%2Fq%2BHB7EmTNPhv0szoEfSPRGpmAK7dY4Xp1DlPJVu555dZlxs2MRVe2NEwli1rxv7RbZbFH%2FsX0o0Go%2FknMT0OfBhuL4%2Bk%2B0QBjOy9ihBdDtqDrBS8znu8vkJQNPCsp8lBWy6hWR%2Faa%2BDgwupy7ywY6sAExZvv0jxbafpbsDrskZfj5ROKz02G%2BxDsn71Gey%2BHP%2BgelDEGLi2hx%2BQaEQfokW4rd1UfgLByVHFl2YhafjCML8V73KKpVs8t30No2tj1JZ382XV0hBrRvu4d0g6cWvO%2FhQNDxSGyRBBlcVJzGIVkFYHOMkkRiwrMYvEFQsbwHZr04OLEQ6eF44b4OlhmnPvwumgO58SgOBC11WgosHBBdNjxLe9EDn5y%2BaXMzQOs5FQ%3D%3D&X-Amz-Signature=e1f699269498bf1142551df8dd8cc022bac2290c3f843c91b8b0976bdbec338f&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
List of the medications prescribed over the week preceding amiodarone hydrochloride prescription
| Medications |
| Vancomycin (Mylan, Hoeilaart, Belgium) |
| Ceftazidim (Kefadim®, Eurocept Pharmaceuticals, Ankeeven, The Netherlands) |
| Piperacillin-tazobactam (Mylan, Hoeilaart, Belgium) |
| Amoxicillin (Clamoxyl®, Sandoz, Vilvoorde, Belgium) |
| Metronidazole (B Braun Medical, Diegem, Belgium) |
| Cefuroxime (Zinacef®, GlaxoSmithKline Pharmaceuticals, Wavre, Belgium) |
| Temocillin (Negaban®, Eumedica SA, Manage, Belgium) |
| Insulin (Actrapid®, Novo Nordisk, Brussels, Belgium) |
| Norepinephrine (Aguetant SA/NV, Brussels, Belgium) |
| Nadroparine (Fraxiparine®, Movianto, Aspen, USA) |
Laboratory data before Day 0, and after amiodarone administration
| Day | Day | Day | Day | Day | Day | Day | Day | Day | Day | Day | Day | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | |
| GGT (NV=<40 IU/L) | 65 | 126 | 305 | 700 | 1172 | 1640 | 1874 | 1507 | 1520 | 1160 | 1267 | 990 |
| Alkaline phosphatase (NV=35-105 IU/L) | 125 | 250 | 369 | 540 | 659 | 734 | 736 | 636 | 626 | 560 | 673 | 549 |
| AST (NV=13-35 IU/L) | 29 | 114 | 80 | 35 | 28 | 23 | 24 | 20 | 22 | 22 | 21 | 17 |
| ALT (NV=7-35 IU/L) | 15 | 19 | 41 | 56 | 57 | 50 | 41 | 40 | 37 | 35 | 37 | 37 |
| Total bilirubin (NV=<1.2 mg/dL) | 0.9 | 1.1 | 1.1 | 1.3 | 1.4 | 1.3 | 1.2 | 1.2 | 1.1 | 0.9 | 0.9 | 0.9 |
| INR (NV=0.80-1.20) | 2.09 | 2.11 | 1.57 | 1.59 | 1.47 | 1.4 | 1.36 | 1.35 | 1.32 | 1.26 | 1.26 | 1.27 |
| Ammonaemia (NV=<90 μg/dL) | - | 179 | 167 | 155 | 139 | 153 | 99 | 79 | 97 | 88 | 111 | 63 |
| Triglycerides (NV=< 150 mg/dL) | - | - | 454 | 438 | 498 | 608 | 604 | - | 444 | 338 | 303 | 223 |
| Arterial lactate (NV=<2.2 mmol/L) | - | 10.4 | 2.9 | 2.0 | 1.3 | 1.4 | 1.9 | 2.0 | 1.5 | 1.4 | 1.9 | 1.9 |
| Urine creatinine) lactate (NV=<50 mmol/mmol | - | 1190 | - | - | - | - | - | - | - | - | - | - |
| Parenteral nutrition | Stop | - | - | - | - | - | - | - | - | - | - | - |
| Enteral nutrition | No | No | 500 ml | No | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml | 500 ml |
| Glucose supplementation | - | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |