BACKGROUNDWe developed a method to determine the urinary concentrations of metabolites in the synthetic pathway for carnitine from N(6)-trimethyllysine and applied this method to determine their excretion in control individuals. In addition, we investigated whether newborns are capable of carnitine synthesis from deuterium-labeled N(6)-trimethyllysine.METHODSUrine samples were first derivatized with methyl chloroformate. Subsequently, the analytes were separated by ion-pair, reversed-phase HPLC and detected online by electrospray tandem mass spectrometry. Stable-isotope-labeled reference compounds were used as internal standards.RESULTSThe method quantified all carnitine biosynthesis metabolites except 4-N-trimethylaminobutyraldehyde. Detection limits were 0.05-0.1 micromol/L. The interassay imprecision (CV) for urine samples with added compounds was 6-12%. The intraassay imprecision (CV) was 1-5% (3-10 micromol/L). Recoveries were 94-106% at 10-20 micromol/L and 98-103% at 100-200 micromol/L. The mean (SD) excretions of N(6)-trimethyllysine and 3-hydroxy-N(6)-trimethyllysine were 2.8 (0.8) and 0.45 (0.15) mmol/mol creatinine, respectively. gamma-Butyrobetaine and carnitine excretions were more variable with values of 0.27 (0.21) and 15 (12) mmol/mol creatinine, respectively. After oral administration of deuterium-labeled N(6)-trimethyllysine, all urines of newborns contained deuterium-labeled N(6)-trimethyllysine, 3-hydroxy-N(6)-trimethyllysine, gamma-butyrobetaine, and carnitine.CONCLUSIONSHPLC in combination with electrospray ionization tandem mass spectrometry allows rapid determination of urinary carnitine biosynthesis metabolites. Newborns can synthesize carnitine from exogenous N(6)-trimethyllysine, albeit at a low rate.