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critique this post with positive without bullet points, don’t include verbatim word form post. In outpatient hemodialysis, nurses frequently monitor for interdialytic complications including muscle cramping and weakness, fatigue, and hypotension. These symptoms are often attributed to fluid shifts resulting from fluid removal; however, carnitine deficiency is overlooked. Deficiency of carnitine in this population, resulting in extreme muscle cramping, often results in patient requesting to end their treatment early and leaving with excess fluid, and waste products such as nitrogen, creatine, and uremic toxins. Carnitine is a key player in energy metabolism and is stored in muscles, and it is noted that serum free-carnitine levels are depleted in patient on maintenance dialysis due to treatment and dietary restrictions (Nishioka et al, 2022; Shimizu et al, 2019). Additionally, hemodialysis patients are at an increased risk for carnitine deficiency due to its continuous loss during treatment. As a nurse, it is extremely frustrating to see patients consistently reporting these symptoms and no action is taken beyond adjustment of their dry weight. Incorporating a carnitine assay and supplementation algorithm when all cases where all other measures (dry weight adjustment, assessment, etc.) were exhausted.

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