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Abbreviations: OCTN2: Organic cation/carnitine transporter 2, SLC22A5: solute carrier family 22 member 5, CACT: Carnitine-acylcarnitine translocase, MCT: Medium-chain triglycerides, CPT I: Carnitine palmitoyltransferase I, CPT II: Carnitine palmitoyltransferase II, TM: trimethyl-lysine, TMLD: trimethyllysine dioxygenase, TMLHE: trimethyllysine hydroxylase deficiency, HTML: 3-hydroxy-trimethyl-lysine, BBD: butyrobetaine dioxygenase, BBOX1: gamma butyrobetaine hydroxylase Secondary carnitine deficiency Secondary carnitine deficiency, also known as carnitine insufficiency, has been linked to a variety of inherited and acquired disorders, which is characterized by low tissue or plasma carnitine levels