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Secondary carnitine deficiencies are most commonly the result of trapping of carnitine in fatty acylcarnitine due to defects in mitochondrial fatty acid -oxidation enzymes such as is the case in medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
doi: 10.1001/jamanetworkopen.2021.22844 37 LeverM.AtkinsonW.GeorgeP
This may occur as part of natural metabolism (158) or when microbes are exposed to drugs that undergo aberrant reactions, such as metronidazole (159161)
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