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A physician may need to evaluate persistent vomiting, severe abdominal pain, signs of dehydration, worsening reflux, gallbladder symptoms, low blood sugar risk in patients using diabetes medications, kidney function concerns, unintentional under-eating, rapid weakness or muscle loss, and medication interactions
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32 Nucleophilic Substitution Reaction of the Hydroxyl Group on L-Carnitine with Propionyl Chloride The hydroxyl group on L-carnitine can also react with nitric acid to form organic nitrate salts