{"id":"ab7eed99-b3cb-5e8a-92ef-e6b2e7a599cf","stable_key":"c9aa15a1-8ba2-5913-b2dd-372af304bf87:fast-carnitine-case","predicate":"deficiency_associated_with","statement":"A post-bypass patient had fasting hypoglycemia, low BHB and high free fatty acids; carnitine replacement resolved fasting hypoglycemia.","claim_class":"observational","status":"source_derived_draft","evidence_grade":"ungraded","direction":"context_dependent","is_public":true,"mechanism_event_id":"f3d4e827-fe21-5c9b-8388-13f0ccbf0f6f","mechanism_event_label":"Fat release was not enough when the next transport step appeared limited.","subject":{"id":"6e34c035-9371-578f-b799-fd2a14e9e40f","slug":"l-carnitine","display_name":"L-Carnitine","entity_type_key":"small_molecule"},"object":{"id":"316577fe-102e-5b9a-a4ff-80cd644819e1","slug":"hypoketotic-hypoglycemia","display_name":"Hypoglycemia with inadequate ketone availability","entity_type_key":"cellular_process"},"evidence_count":1,"mechanism_event":{"id":"f3d4e827-fe21-5c9b-8388-13f0ccbf0f6f","stable_key":"c9aa15a1-8ba2-5913-b2dd-372af304bf87:fast-carnitine-case-event","event_type":"observed_relationship","label":"Fat release was not enough when the next transport step appeared limited.","description":"A post-bypass patient had fasting hypoglycemia, low BHB and high free fatty acids; carnitine replacement resolved fasting hypoglycemia.","status":"provisional","compartment":null,"participants":[{"entity":{"id":"6e34c035-9371-578f-b799-fd2a14e9e40f","slug":"l-carnitine","display_name":"L-Carnitine","entity_type_key":"small_molecule"},"role":"subject","stoichiometry":null,"state_label":"","sequence_order":0,"notes":""},{"entity":{"id":"316577fe-102e-5b9a-a4ff-80cd644819e1","slug":"hypoketotic-hypoglycemia","display_name":"Hypoglycemia with inadequate ketone availability","entity_type_key":"cellular_process"},"role":"target","stoichiometry":null,"state_label":"","sequence_order":1,"notes":""},{"entity":{"id":"399b71e9-675f-5044-b2f3-7bcda41aaccb","slug":"ketogenesis","display_name":"Ketone-body production","entity_type_key":"cellular_process"},"role":"context_participant","stoichiometry":null,"state_label":"","sequence_order":2,"notes":""},{"entity":{"id":"6f7b5cda-ae0c-5b01-8aad-5e28676ac316","slug":"serum-beta-hydroxybutyrate","display_name":"Human serum beta-hydroxybutyrate concentration","entity_type_key":"cellular_process"},"role":"context_participant","stoichiometry":null,"state_label":"","sequence_order":3,"notes":""},{"entity":{"id":"f8030dfa-1be6-574d-bcc9-fc985fb8bc4f","slug":"serum-free-fatty-acids","display_name":"Human serum free fatty acid concentration","entity_type_key":"cellular_process"},"role":"context_participant","stoichiometry":null,"state_label":"","sequence_order":4,"notes":""}]},"contexts":[{"dimension":"availability_state","value_text":"nutrient_deficiency","comparator":null,"unit":null,"notes":"Imported condition classification; unverified.","entity":null},{"dimension":"evidence_access","value_text":"Primary abstract","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"experimental_model","value_text":"Cachectic 69-year-old woman, 12 years after gastric bypass; supervised diagnostic fast.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"limitations","value_text":"Single case; impaired mitochondrial transport was inferred. This is not a general carnitine supplement recommendation.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"nutrient_topic","value_text":"Fasting physiological-state collection; human protocols, cellular deprivation and refeeding are distinguished.","comparator":null,"unit":null,"notes":"","entity":{"slug":"fasting","display_name":"Fasting / abstention from energy intake","entity_type_key":"cellular_process"}},{"dimension":"plain_language","value_text":"Fat release was not enough when the next transport step appeared limited.","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"primary_references","value_text":"Fasting hypoglycaemia secondary to carnitine deficiency: a late consequence of gastric bypass. · 2021 · https://pubmed.ncbi.nlm.nih.gov/34281938/ · DOI 10.1136/bcr-2021-241703","comparator":null,"unit":null,"notes":"","entity":null},{"dimension":"trigger_kind","value_text":"nutrient_deficiency","comparator":null,"unit":null,"notes":"Imported condition classification; unverified.","entity":null}],"evidence":[{"id":"7816e5af-f7c2-50cd-9f62-26c2894e5668","evidence_kind":"source_excerpt","locator":"Lines 168-174","start_line":168,"end_line":174,"excerpt":"## fast-carnitine-case\nFat release was not enough when the next transport step appeared limited.\nA post-bypass patient had fasting hypoglycemia, low BHB and high free fatty acids; carnitine replacement resolved fasting hypoglycemia.\nModel: Cachectic 69-year-old woman, 12 years after gastric bypass; supervised diagnostic fast.\nLimitations: Single case; impaired mitochondrial transport was inferred. This is not a general carnitine supplement recommendation.\nEvidence access: Primary abstract\nFasting hypoglycaemia secondary to carnitine deficiency: a late consequence of gastric bypass. · 2021 · https://pubmed.ncbi.nlm.nih.gov/34281938/ · DOI 10.1136/bcr-2021-241703","model_system":"Cachectic 69-year-old woman, 12 years after gastric bypass; supervised diagnostic fast.","directness":"reported_statement","verification_status":"source_derived_draft","notes":"Original curation paraphrase; evidence access and experimental limitations specified.","relationship":"supports","weight":1.0,"link_notes":"","source":{"id":"921d1eb5-2c88-52b9-9898-60b2b5bf6029","stable_key":"import-c9aa15a1-8ba2-5913-b2dd-372af304bf87","title":"Fasting: fuel switching, nutrient sensing, ketone signaling, nutrient dependencies and refeeding (2026-09-18)","document_type":"imported_text","citation_label":"AI-assisted research curation; primary-abstract references and experimental limitations individually identified. Not publisher full text.","file_path":"","sha256":"991b7fd94be84c0f1e622e0672eda03d600b388dfd7825e219aa1678d1c7983a","revision_id":"ce85d3f4-4eaf-5aee-bddb-0f0ce7fe2211","review_status":"unverified_draft","notes":""}}],"relations":[],"conflicts":[],"corrections":[],"research":null}