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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