difference between n-acetyl carnitine and l-carnitine Acetyl-L-Carnitine L-Carnitine vs Acetyl L-Carnitine: Differences,

Within this group, 10 (55.6%) patients developed low free carnitine during the first follow-up (3 to 9 months) timepoint

10.3389/fmolb.2022.1007768 334 WuW.GengP.ZhuJ.LiJ.ZhangL.ChenW.et al (2019)

Cytokine storms manifest with a range of clinical symptoms, including fever, hepatosplenomegaly, progressive liver failure with coagulopathy, cytopenia, and hyperferritinemia

As I said, becoming symptomatic quickly may indicate that more frequent/lower dose B12 is a better treatment strategy, not that liver or other stores cannot be utilized

Ashla AA, Hoshikawa Y, Tsuchiya H et al (2010) Genetic analysis of expression profile involved in retinoid metabolism in non-alcoholic fatty liver disease