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When symptoms do appear, they are often vague and easily overlooked: Because obvious symptoms are often absent, the condition is frequently discovered accidentally during blood tests (showing elevated liver enzymes) or imaging scans (such as ultrasounds or CT scans) performed for other reasons

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None of that is complicated for a trained professional, and that is the point worth stressing

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This multi-step enzymatic process culminates with -butyrobetaine dioxygenase (-BBD) catalyzing the final conversion of -butyrobetaine to carnitine