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Genetic mutations that give rise to the deficiency of FMO3 cause a disorder called trimethylaminuria, in which TMA is excreted in body fluids such as urine, sweat, and breath, with the characteristic fishy odor

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[10] In these situations an oral supplement may be inadequate or too slow, so clinicians rely on intravenous or intramuscular levocarnitine

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Particular attention should be paid to optical purity, as the content of D-lysine is typically used as an important parameter for process control and raw material purity

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Furthermore, the combined therapy was associated with better treatment adherence

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Considering that 10% or more of cirrhotic patients have HE, and 50% of cirrhotic patients with MHE who have not been treated can progress to OHE within 424 months [386], it is necessary to change the paradigm of treatment to improve the HRQoL of patients

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