Carnitine Palmitoyltransferase IA (CPT1A) deficiency is a very rare disorder of long-chain fatty acid oxidation that typically presents in childhood after a period of fasting or metabolic stress with a Reye-like illness: hypoketotic hypoglycemia, hepatomegaly, sudden onset of liver failure, seizures and in some instances coma. Between such episodes, individuals appear developmentally normal unless past episodes have resulted in neurological damage. Involvement of cardiac and skeletal muscle is typically not present; however, several cases with slight cardiomegaly or bradycardia have been described. At this time, a single individual homozygous for the P479L mutation presented as an adult with recurrent episodes of activity-induced muscle pain with elevated serum creatine kinase. Acute fatty liver of pregnancy (AFLP) or maternal HELLP syndrome (hypertension, elevated liver enzymes, low platelets) may occur in a pregnant woman carrying a fetus with CPT1A deficiency.