Science review Carnitine in the treatment of valproic acid-induced toxicity – what is the evidence 英文参考文献.docVIP

Available online /content/9/5/431 Review Science review: Carnitine in the treatment of valproic acid-induced toxicity – what is the evidence? Philippe ER Lheureux, Andrea Penaloza, Soheil Zahir and Mireille Gris Department of Emergency Medicine, Acute Poisoning Unit, Erasme University Hospital, Brussels, Belgium Corresponding author: Philippe ER Lheureux, plheureu@ulb.ac.be Published online: 10 June 2005 Critical Care 2005, 9:431-440 (DOI 10.1186/cc3742) This article is online at /content/9/5/431 ? 2005 BioMed Central Ltd Abstract It is usually well tolerated. Indeed, VPA has fewer common side effects than do other AEDs, especially on behaviour and cognitive functions. Moreover, its adverse effects can often be minimized by initiating the drug slowly. However, rare serious complications may occur in some patients receiving VPA chronically, including fatal haemorrhagic pancreatitis, bone marrow suppression, VPA-induced hepatotoxicity (VHT) and VPA-induced hyperammonaemic encephalopathy (VHE). Some data suggest that VHT and VHE may be promoted either by a pre-existing carnitine deficiency or by deficiency induced by VPA per se. Valproic acid (VPA) is a broad-spectrum antiepileptic drug and is usually well tolerated, but rare serious complications may occur in some patients receiving VPA chronically, including haemorrhagic pancreatitis, bone marrow suppression, VPA-induced hepato- toxicity (VHT) and VPA-induced hyperammonaemic encephalo- pathy (VHE). Some data suggest that VHT and VHE may be promoted by carnitine deficiency. Acute VPA intoxication also occurs as a consequence of intentional or accidental overdose and its incidence is increasing, because of use of VPA in psychiatric disorders. Although it usually results in mild central nervous system depression, serious toxicity and even fatal cases have been reported. Several studies or i