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The practice of doubling the infusion rate is increasingly accepted, but tripling or quadrupling the dose remains more controversial

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After three steps of peroxisomal -oxidation, the medium-chain fatty acid product (4,8-dimethylnonanoic acid) is esterified to carnitine and transported out of the peroxisome for uptake by the mitochondria where it is further oxidized via the mitochondrial -oxidation pathway