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6.6 When to Refer Referral to a clinician or dietitian may be appropriate when: Persistent GI intolerance limits intake Weight loss exceeds 20% body weight Multiple laboratory abnormalities are present Underlying malabsorptive or gastrointestinal disease exists Patient is elderly or medically complex GLP-1 therapy should not occur in isolation from nutritional oversight when risk factors are present

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Li M, Xu S, Geng Y et al (2019) The protective effects of L-carnitine on myocardial ischaemiareperfusion injury in patients with rheumatic valvular heart disease undergoing CPB surgery are associated with the suppression of NF-B pathway and the activation of Nrf2 pathway

doi: 10.1007/s11154-016-9363-2

In these cases, injections may be a more effective option