{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T07:31:21Z","timestamp":1770276681836,"version":"3.49.0"},"reference-count":7,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,1]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>Twelve years following gastric bypass surgery, a cachectic 69-year-old woman presented with both fasting and postprandial hypoglycaemia. Postprandial symptoms were relieved by dietary modification and acarbose, as is common in such cases. During a supervised fast, symptomatic hypoglycaemia occurred. Concurrent laboratory testing showed suppression of plasma insulin, c-peptide, proinsulin and insulin-like growth factor II. However, beta-hydroxybutyrate was also low, surprising given insulin deficiency. Elevated plasma free fatty acid (FFA) concentrations suggested that lipolysis was not impaired, making cachexia\/malnutrition a less likely cause of hypoglycaemia. The apparent diagnosis was failure to counter-regulate\u2014subsequent plasma carnitine measurements showed carnitine deficiency which presumably prevented FFA transport across mitochondrial membranes for ketogenesis. Repletion with high-dose oral carnitine supplements effected resolution of fasting hypoglycaemia.<\/jats:p>","DOI":"10.1136\/bcr-2021-241703","type":"journal-article","created":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T10:50:22Z","timestamp":1626691822000},"page":"e241703","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Fasting hypoglycaemia secondary to carnitine deficiency: a late consequence of gastric bypass"],"prefix":"10.1136","volume":"14","author":[{"given":"Xin","family":"Chen","sequence":"first","affiliation":[{"name":"University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brad","family":"Kimura","sequence":"additional","affiliation":[{"name":"University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jodi","family":"Nagelberg","sequence":"additional","affiliation":[{"name":"University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen C","family":"McCowen","sequence":"additional","affiliation":[{"name":"University of California San Diego, La Jolla, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,19]]},"reference":[{"key":"2025082801461203000_14.7.e241703.1","first-page":"18","article-title":"An unusual presentation of post gastric bypass hypoglycemia with both postprandial and fasting hypoglycemia","volume":"2018","author":"Chen","year":"2018","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"key":"2025082801461203000_14.7.e241703.2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1410"},{"key":"2025082801461203000_14.7.e241703.3","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-007-0473-0"},{"key":"2025082801461203000_14.7.e241703.4","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/1743-7075-7-30","article-title":"Role of carnitine in disease","volume":"7","author":"Flanagan","year":"2010","journal-title":"Nutr Metab"},{"key":"2025082801461203000_14.7.e241703.5","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.K07-044"},{"key":"2025082801461203000_14.7.e241703.6","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5234\/cnpt.3.37","article-title":"Carnitine deficiency and severe hypoglycemia associated with valproic acid","volume":"3","author":"Nagamine","year":"2012","journal-title":"Clinical Neuropsychopharmacology and Therapeutics"},{"key":"2025082801461203000_14.7.e241703.7","doi-asserted-by":"publisher","DOI":"10.1097\/00125817-199811000-00008"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241703","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:46:18Z","timestamp":1756370778000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":7,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,19]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bcr-2021-241703"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241703","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}