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Three RCTs [18, 32, 33] involving 192 patients provided moderate certainty evidence (Table 2) that L-carnitine supplementation probably has little or no difference in adverse events (RR: 0.72, 95%CI: 0.47 to 1.08)

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As organic acid testing to determine pyroglutamate is usually performed only at specialized pediatric hospitals with specialized biochemical genetics services, the diagnosis of this metabolic disorder in patients may frequently be missed