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While you should have suspicion for this pathology in any patient presenting with altered mental status on valproic acid, the following factors may place the patient at an increased risk for this complication: Anticonvulsant polytherapy and medication interactions Medications such as topiramate, phenytoin, carbamazepine, and phenobarbital have been associated with increased ammonia levels when used in conjunction with valproic acid Renal failure Hepatic failure Carnitine deficiency: Carnitine assists with the elimination of valproic acid and minimizes the formation of harmful valproic acid metabolites

The Science Behind Fat Metabolism At the cellular level, fat metabolism is a multi-step process that converts stored fat into usable energy

In these cases L-carnitine is a conditionally essential nutrient that must be obtained through supplementation and/or from high carnitine whole foods including meat and seafood

2021 Jun;73:81-90

Applications which are not likely to meet the criteria for Expedited Review should be submitted at least two weeks prior to the meeting at which it would be reviewed

Notes on nomenclature: NAFLD and NASH correspond to MASLD and MASH, respectively, according to the current consensus