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Bariatric surgery (including gastric bypass via Roux-en-Y or blind-loop intestinal bypass): Multifactorial, including systemic catabolism, steroid, tacrolimus, nutritional deficiencies (e.g., carnitine) investigation & monitoring investigation & monitoring interpreting the NH3 level This is discussed below in the treatment section

Apoptosis is a natural biological process that occurs during normal cell development to maintain cell homeostasis but it can also be triggered by toxic agents such as ROS