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3, always happens during dialysis and continue for 4 hours or longer

The problem is that muscles have about 1,000x higher carnitine concentration than blood

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It can also decrease the cellular action of circulating thyroid hormones, potentially interfering with medications like Levothyroxine used for hypothyroidism, which could paradoxically worsen fatigue if unmonitored
doi: 10.1016/j.jfma.2018.09.017