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Common causes encompass metabolic disorders like fatty acid oxidation defects and organic acidemias, renal issues such as carnitine loss due to chronic renal failure, Fanconi syndrome, dialysis, or certain medications (e.g., vancomycin), dietary factors including vegetarianism, starvation, or specific diets like the ketogenic diet, and liver diseases such as cirrhosis and fatty liver

A licensed provider will typically start you at a low dose and gradually increase it over time to find the level that balances effectiveness with tolerability

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