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doi:10.2337/db13-0887

** In subjects with severely impaired renal function or on dialysis, chronic oral administration of L-carnitine can lead to accumulation of TMA and TMAO in the blood resulting in trimethylaminuria, a pathological condition characterized by a strong "fishy odor" present in the urine , in the patient's breath and sweat *** Mild myasthenic symptoms have been reported in uremic patients **** Injection site reactions have been reported in iv administration only ***** Very rare cases of increased INR (International Normalized Ratio) have been reported in patients receiving concomitant coumarin therapy

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