tailieunhanh - Báo cáo khoa học: " Science review: Carnitine in the treatment of valproic acid-induced toxicity – what is the evidence"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Science review: Carnitine in the treatment of valproic acid-induced toxicity – what is the evidence? | Available online http 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@ Published online 10 June 2005 This article is online at http content 9 5 431 2005 BioMed Central Ltd Critical Care 2005 9 431-440 DOI cc3742 Abstract 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 hepatotoxicity VHT and VPA-induced hyperammonaemic encephalopathy 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 isolated clinical observations have suggested the potential value of oral L-carnitine in reversing carnitine deficiency or preventing its development as well as some adverse effects due to VPA. Carnitine supplementation during VPA therapy in high-risk patients is now recommended by some scientific committees and textbooks especially paediatricians. L-carnitine therapy could also be valuable in those patients who develop VHT or VHE. A few isolated observations also suggest that L-carnitine may be useful in patients with coma or in preventing hepatic dysfunction after acute VPA overdose. However these issues deserve further investigation in controlled randomized and probably multicentre trials to evaluate the clinical value and .