ArticleThe Journal of international medical research2017
L-Carnitine supplementation to reverse hyperammonemia in a patient undergoing chronic valproic acid treatment: A case report.
Article in The Journal of international medical research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 30 citations in OpenAlex.
- Risk factors for carnitine deficiency in critically ill adults: A descriptive cross-sectional study.JPEN. Journal of parenteral and enteral nutrition · 2026Article
- L-carnitine for valproic acid-induced toxicity.British journal of clinical pharmacology · 2025Review
- Hyperammonemia in Inherited Metabolic Diseases.Cellular and molecular neurobiology · 2022Review
- The effect of sodium benzoate, L-carnitine, and phenylacetate on valproate-induced hyperammonemia in Male Wistar rats.International journal of physiology, pathophysiology and pharmacology · 2022Article
- Management of antiepileptic drug-induced nutrition-related adverse effects.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2020Review
- Molecular, biochemical, and clinical analyses of five patients with carbamoyl phosphate synthetase 1 deficiency.Journal of clinical laboratory analysis · 2020Article
- Features of Adult Hyperammonemia Not Due to Liver Failure in the ICU.Critical care medicine · 2018Observational
- The Pharmabiotic Approach to Treat Hyperammonemia.Nutrients · 2018Review
- Valproic acid induced acute liver injury resulting in hepatic encephalopathy- a case report and literature review.Journal of community hospital internal medicine perspectives · 2018Article
- Lamotrigine-Valproic Acid Interaction Leading to Stevens-Johnson Syndrome.Case reports in medicine · 2018Article
- Hypoxic respiratory failure due to hyperammonemic encephalopathy induced by concurrent use of valproic acid and topiramate, a case report and review of the literature.Respiratory medicine case reports · 2018Article
- Valproate-Induced Hyperammonemic Encephalopathy.Cureus · 2017Article
- The Story of Ammonia in Liver Disease: An Unraveling Continuum.Journal of clinical and experimental hepatologyReview
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Valproic acid is a broad-spectrum anticonvulsant that has also gained attention in the psychiatric setting. With respect to safety, valproic acid may induce a seemingly rare condition, hyperammonemia, which can induce a wide variety of symptoms ranging from irritability to coma. The proposed mechanism of hyperammonemia involves depletion of carnitine and overproduction of a toxic metabolite, 4-en-valproic acid, both of which impair the urea cycle and thus ammonia elimination. Carnitine is a commonly used antidote for acute intoxication of valproic acid, but is not a therapeutic option for management of chronic adults with adverse effects related to valproic acid. We herein report a case involving a woman with epilepsy who developed hyperammonemia after a change in her anticonvulsant therapy. She reported increased seizures and gastrointestinal disturbances. Her ammonia, valproic acid, 4-en-valproic acid, and carnitine levels were monitored. Her ammonia level was elevated and her carnitine level was at the inferior limit of the population range. She was supplemented with carnitine at 1 g/day. After 1 month, her ammonia level decreased, her carnitine level increased, and her seizures were better controlled. Carnitine supplementation was useful for reversal of her hyperammonemia, allowing her to continue valproic acid for seizure control.
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