+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

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



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



Innovations in Clinical Neuroscience 12(9-10): 18-24



The aim of this study was to investigate the effect of levocarnitine (active isoform of carnitine, L-Carnitine) supplementation on serum ammonia and carnitine levels simultaneously, and their clinical outcomes in valproic acid-treated psychiatric subjects. This was a propsective study of 22 psychiatric patients. A fixed dose of levocarnitine was coadministrated over a period of three months in subjects with valproic acid-induced hyperammonemia. Serum ammonia, valproic acid, and carnitine concentrations were measured, and psychiatric symptoms were recorded at baseline and one, two, and three months. Sequential change of the levels of serum ammonia, valproic acid, free carnitine, acylcarnitine, total carnitine, ratios of acylcarnitine/free carnitine, and the scores of Brief Psychotic Rating Scale, Clinical Global Impression-Severity scale, and the Global Assessment of Functioning scale were compared within total subjects and two groups divided by the effectiveness of levocarnitine supplementation against baseline hyperammonemia. Within total subjects, free carnitine, acylcarnitine, and total carnitine levels were significantly increased without statistical change in serum ammonia, valproic acid levels, and acylcarnitine/free carnitine ratio, while a part of Brief Psychotic Rating Scale scores was decreased. Acylcarnitine levels were significantly increased at all points in the levocarnitine effective group and not in the noneffective group. Acylcarnitine/free carnitine ratio increased in the levocarnitine effective group and decreased in the noneffective group, which was confirmed by negative correlation between the ratio of serum ammonia levels at three months to serum ammonia levels at baseline and the ratio of acylcarnitine/free carnitine levels at three months to acylcarnitine/free carnitine levels at baseline. 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.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 059001208

Download citation: RISBibTeXText

PMID: 26634177


Related references

Carnitine deficiency and hyperammonemia associated with valproic acid therapy. Journal of Pediatrics 101(5): 782-785, 1982

Valproic acid impairs carnitine uptake in cultured human skin fibroblasts. An in vitro model for the pathogenesis of valproic acid-associated carnitine deficiency. Pediatric Research 34(3): 281-287, 1993

Carnitine deficiency and hyperammonemia in children receiving valproic acid with and without other anticonvulsant drugs. International Journal of Clinical & Laboratory Research 29(1): 36-40, 1999

L-Carnitine supplementation to reverse hyperammonemia in a patient undergoing chronic valproic acid treatment: A case report. Journal of International Medical Research 45(3): 1268-1272, 2017

Effect of L-carnitine supplementation on cardiac carnitine palmitoyltransferase activities and plasma carnitine concentrations in adriamycin-treated rats. Pediatric Research 53(5): 788-792, 2003

A child with valproic acid-associated carnitine deficiency and carnitine-responsive cardiac dysfunction. Journal of Child Neurology 7(4): 413-416, 1992

Effect of carnitine and essential fatty acid supplementation on the uptake of 11C-carnitine in muscle of a myopathic carnitine-deficient patient using positron emission scintigraphy. Prostaglandins Leukotrienes & Essential Fatty Acids. 58(3): 201-204, Ch, 1998

Carnitine levels in skeletal muscle, blood, and urine in patients with primary carnitine deficiency during intermission of L-carnitine supplementation. Jimd Reports 20: 103-111, 2015

Role of carnitine in the regulation of glucose homeostasis and insulin sensitivity: evidence from in vivo and in vitro studies with carnitine supplementation and carnitine deficiency. European Journal of Nutrition 51(1): 1-18, 2012

L-carnitine in valproic acid-induced hyperammonemia. Medicina Intensiva 38(2): 124-125, 2014

Carnitine for valproic acid-induced hyperammonemia. American Journal of Psychiatry 154(8): 1168-1169, 1997

Increased fatty acid clearance with carnitine supplementation in carnitine deficiency. Pediatric Research 20(4 Part 2): 334A, 1986

Possible increased fatty acid clearance with carnitine supplementation in carnitine deficiency. Clinical Research 33(4): 896A, 1985

Renal handling of carnitine in children with carnitine deficiency and hyperammonemia associated with valproate therapy. Journal of Pediatrics 109(1): 131-134, 1986

Carnitine levels in valproic acid-treated psychiatric patients: a cross-sectional study. Journal of Clinical Psychiatry 66(5): 555-558, 2005