L-Carnitine supplementation has been shown to boost muscular performance in several studies. In hemodialysis patients with muscular weakness, fatigue, or cramps/aches, after L-carnitine treatment, about two-thirds of patients had at least some improvement in muscular symptoms . L-Carnitine was also found to improve the left ventricular ejection fraction (LVEF) in hemodialysis patients with cardiac morbidity who had significantly reduced LVEF in echocardiography before supplementation. Moreover, L-Carnitine has been shown to improve muscular function and exercise performance in athletes in several studies

Inclusion Criteria:

• Age from 21 years old or greater
• Both genders have respiratory failure either of the primary medical origin or in the post-surgical course.
• Not in need of mechanical ventilation

Exclusion Criteria:

• Renal failure on regular dialysis
• Hypothyroidism
• Seizures
• End-stage liver disease
• Mechanical ventilation
• History or discovered allergy to L-carnitine, pivampicillin, and other pivalate-conjugated antibiotics.