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10.1016/s0005-2736(99)00174-1 [DOI] [PubMed] [Google Scholar] Mnayer D., Fabiano-Tixier A

In older children or adults it may be considered if there are clinical symptoms suggestive of carnitine deficiency (hypotonia, lethargy), a significant decrease in the serum free carnitine levels, an impairment in hepatic function tests, or hyperammonaemia, even in the absence of VHE

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