In an executive order in May announcing the plan, the president noted that Americans often pay almost three times more for the exact same medicines, often made in the exact same factories

The muscle carnitine levels rise slightly (only up to 5% to 10% of controls), due to the abnormal OCTN2 which is unable to increase the uptake of carnitine into the myocyte adequately.[5][8] Carnitine enters mostly by passive diffusion from plasma and via low-affinity transporters, and this modest increase is enough to prevent muscle complications.[8] Acute episodes of hypoglycemia in children with PCD are promptly treated with intravenous 10% dextrose and treatment of accompanying metabolic abnormalities (e.g., acid-base abnormalities), along with immediate carnitine supplementation.[8][17][8] It is crucial to avoid episodes of hypoglycemia in PCD by frequent feeding and avoiding fast states.[17] Differential Diagnosis Secondary carnitine deficiency (SCD) could result from multiple causes, either from a decrease in carnitine intake or more commonly from an increase in renal excretion
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