l-carnitine was safely administered in the setting of valproate toxicity

Background l-Carnitine is a carnitine replacement that has been used in carnitine deficiency states. We conducted a review of patients with acute valproate (VPA) poisoning that had an elevated ammonia level and received l-carnitine to address safety. Methods After a brief training of systematic chart review, reviewers blinded to the purpose of the study completed a standardized data collection sheet. Ages, outcomes, side effects, presence of hyperammonemia, and total carnitine doses were recorded. Results Three years of poison center charts from more than 300 000 patients were reviewed; 674 patients ingested valproic acid. The median age was 26.2 years (range, 1-58 years). l-Carnitine was routinely recommended if the ammonia level was elevated. Fifty-five doses of carnitine were administered to 19 patients who had isolated VPA ingestions and 196 doses of carnitine were administered to patients with mixed overdoses that included VPA, all with an elevated ammonia level. No patient had a documented allergic reaction or side effects. Conclusions Two hundred fifty-one l-carnitine doses were not associated with adverse or toxic effects in our VPA toxic patients.