A 33 Year Old Woman With Altered Mental Status and Elevated Ammonia Level CHEST Valproic Acid Toxicity When the calmer becomes the culprit In the ICU, some tox cases whisper and some unravel like a metabolic domino cascade. Valproate toxicity belongs to the latter. Valproic Acid Toxicity When the calmer becomes the culprit In the ICU, some tox cases whisper and some unravel like a metabolic domino cascade. Valproate toxicity belongs to the latter. L carnitine does not improve valproic acid poisoning management: a cohort study with toxicokinetics and concentration effect relationships Annals of Intensive Care Springer Nature Link Hyperammonemia Due to Valproic Acid in the Psychiatric Setting American Journal of Psychiatry What are the side effects of Depakote (valproate) toxicity, particularly in patients with pre existing liver or kidney disease?