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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

(Berlin: Springer), 89107

P., & Callaghan, B

Lancet Diabetes Endocrinol (2018) 6:27586

Nearly 1 in 4 respondents (24%) felt individuals should start taking everyday steps to support brain health before age 35

The protective role of l-carnitine on oxidative stress, neurotransmitter perturbations, astrogliosis, and apoptosis induced by thiamethoxam in the brains of male rats