Historical QOD 12/28/08: What is the metabolite responsible for hepatotoxicity in acute valproate overdose?
4-en-VPA, a byproduct of omega oxidation, is the toxic metabolite that accumulates in acute valproate overdose once carnitine depletion occurs. 4-en-VPA is responsible for hyperammonemia seen in toxicity.
Lheureux PE, Penaloza A, Zahir S, Gris M. Science review: carnitine in the treatment of valproic acid-induced toxicity – what is the evidence? Crit Care. 2005 Oct 5;9(5):431-40. doi: 10.1186/cc3742. Epub 2005 Jun 10. PMID: 16277730; PMCID: PMC1297603.
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