aciduria in urinary organic acid and LC-MS/MS results led us to consider defects in fattyacid β-oxidation. As in previously reportedcases, our patients had high blood levels ofammonia, ALT, AST, LDH, highly elevatedC16, C16.1 carnitine esters, moderately elevatedC18 carnitine esters, and low concentrationsof C0 free carnitine.1-3,5,6,11 The diets given,treatment options, biochemical and clinicalfeatures were alike in all three CACTD patients.Unfortunately, their life spans were limiteddespite supportive care efforts.