Schommers et al., 2017) and modified the expression of genes related to mitochondria (Yang et al., 2021), potentially leading to a rise in anaerobic glucose metabolism
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
doi:10.1016/j.heares.2023.108786 Pournajaf S, Baerz MM, Khoshsirat S
During stress, a temporary cortisol surge tries to fight off the stress: heart rate increases, breathing gets heavy, blood pressure and blood sugar rise, and muscles get tense
