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Secondary carnitine deficiency is much more common and can result from numerous causes: chronic kidney disease (especially in dialysis patients), certain medications (valproic acid, pivalic acid antibiotics, cisplatin), organic acidurias, fatty acid oxidation disorders, liver cirrhosis, malnutrition, vegetarian diets, aging, and high-demand states such as pregnancy, intensive exercise, or critical illness

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The copper ion appears to stabilize and deliver GHK to cells