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Secondary deficiency may occur in certain conditions including kidney disease requiring dialysis, where L-carnitine supplementation is often beneficial

the combination L-lysine and L-carnitine is a direct combination in the form of salt

Basically, the superoxide free radical (for example from leak from complex I in mitochondria and biochemically by reactions involving xanthine/xanthine oxidase or NADPH oxidase) and nitric oxide [NO, formed by catalytic action of nitric oxide synthase (NOS) on arginine] react in a radical-radical recombination to form peroxynitrite, a nonradical (38, 39)

In view of these important functions, carnitine is increasingly detectable, particularly in tissues such as the skeletal and cardiac muscles, which use fatty acids as a food fuel