The Effect of Carnitine Supplementation on Hyperammonemia and Carnitine Deficiency Treated with Valproic Acid in a Psychiatric Setting

Conclusion: In valproic acid-treated psychiatric patients,  carnitine supplementation resulted in overall improvement in mental status. Improvement of hyperammonemia and carnitine deficiency in this group may be related to mitochondrial function. Introduction Valproic acid (valproate, VPA) is a branched, medium-chain fatty acid agent having a broad-spectrum antiepileptic action. In the psychiatry clinical setting, VPA is frequently used for several psychiatric disorders as a mood stabilizer and combined with various types of antipsychotics.[1] Adverse reactions to VPA involve neurological, hematopoietic, hepatic, and digestive systems.[2] Among the metabolic disorders, VPA-induced hyperammonemia,[3] which is characterized by lethargy, vomiting, cognitive slowing, focal neurological deficits, and decreasing consciousness ranging from drowsiness to coma, is an important clinical consideration.3 In psychiatric patients, VHE may be difficult to differentiate from the exacerbation of psychiatric symptoms. The exact mechanism of VHE remains unclear but is believed to be related to the accumulation of toxic VPA metabolites and elevated ammonia (NH3) levels.[4] Carnitine is an essential cofactor in the proper metabolism of VPA and NH3 elimination. A severe carnitine deficiency is thought to contribute to VHE.[5] Although the precise mechanism leading to hypocarnitinemia in patients treated with valproate is not known, a previous clinical study showed a significant decrease in carnit...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Bipolar Disorder Current Issue Epilepsy Mental Disorders Neurology Original Research Psychiatry Psychopharmacology Schizophrenia Traumatic Brain Injury carnitine deficiency hyperammonemia Levocarnitine psychiatric setting valpr Source Type: research