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elevated P1NP (bone formation marker) by 58%

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That being said, BMI is just one part of the equation and often doesnt reflect a patients entire medical story

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They could be sharing vials, and needles, using the same gloves for multiple patients, not correctly cleaning their premises, or not correctly preparing the area theyre treating

Carnitine deficiency can theoretically cause hyperammonemia, but in practice this seems to be a less important mechanism (especially among patients being treated with IV carnitine)