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A 2019 systematic review of five placebo-controlled trials conducted by one group of investigators examined the effect of acetyl-L-carnitine (ALCAR) in 398 participants with cirrhosis and portal hypertension (high blood pressure in the portal vein) and presenting with either subclinical or overt hepatic encephalopathy

Impact of long-term TPN and dialysis Prolonged TPN lacking added carnitine can decrease plasma concentrations, which affects fatty acid metabolism especially in infants and adults with compromised liver function

Carnitine participates in cell volume and fluid balancing in all tissues that are affected by the tonicity (iso-, hyper- hypo- tonicity) of the extracellular environment [19]

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L-carnitine reduces lipid peroxidation through the scavenging of free radicals and the enhancement of the mitochondrial membrane structural integrity