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Children concomitantly taking pivampicillin and other pivalate-conjugated antibiotics may also have reduced blood carnitine concentration levels

L-Carnitine is important in transporting long-chain fatty acids into the mitochondria, where fat is turned into adenosine triphosphate (ATP) which fuels our bodies and contracts our muscles

Therefore, assuming that her condition is due to accumulation of propionyl CoA that cannot be metabolised onwards to methylmalonyl CoA and then the citric acid cycle intermediate succinyl CoA, we can explain her adverse reaction to milk

[DOI] [PubMed] [Google Scholar] 115.Cruz F, Scott SR, Barroso I, Santisteban P, Cerdan S

Sigauke E, Rakheja D, Kitson K, Bennett MJ: Carnitine palmitoyltransferase II deficiency: a clinical, biochemical, and molecular review