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The pathogenesis of hyperammonaemic encephalopathy is still incompletely understood, and a detailed discussion of the topic is beyond the scope of this review

Zeisel, S.H., Mar, M.H., Howe, J.C

J Appl Physiol (1985)

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These synthetic forms are not biologically active in the same way as the natural L-isomer and can actually competitively inhibit the absorption and utilization of naturally occurring L-carnitine, potentially inducing a state of carnitine deficiency and worsening fatigue symptoms