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When determining the Alanine to Lysine ratio as an indirect measure of mitochondrial distress we found that unaffected children had an average ratio of 5.8 and those with konzo have an average ratio of 6.9, both of which are substantially higher than the expected ratio of less than 3 for healthy adolescents (Fig

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10.1016/S0140-6736(84)92209-8 Stumpf DA, Parker WD, Haas R: Carnitine deficiency with valproate therapy