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Acylcarnitines that accumulate through disordered carnitine metabolism directly inhibit the surface activity of pulmonary surfactants and are considered risk factors for increased lung injury due to a second hit, such as respiratory tract infection, sepsis, or inhalation of toxins, in patients with dysregulated FAO [304, 305]

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Besides the acute phase gastrointestinal effects which may lead to up to 10% of people discontinuing the drugs, there are other potential GI side effects of obstruction, excessive loss of muscle mass, and potentially association with some eye disease adverse events