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William J. Triggs, MD; Timothy P. Bohan, PhD, MD; Shen-Nan Lin, PhD; L. James Willmore, MD

Arch Neurol. 1990;47(10):1131-1133.

Abstract
• We observed two patients who developed coma following administration of valproate in dosages of 32 to 40 mg/kg per day. Valproate levels were within the therapeutic range, and results of liver function studies were normal. Both patients had ketosis and adipic aciduria. Plasma free carnitine levels were decreased during coma and after recovery. One patient excreted ethylmalonic acid, butyrylcarnitine, and glutarylcarnitine during and after resolution of coma, suggesting a multiple acyl coenzyme A dehydrogenation defect. Low serum carnitine levels may predispose patients to development of altered consciousness when treated with valproate.

Author Affiliations
From the Departments of Neurology (Drs Triggs and Willmore), Pharmacology (Dr Bohan), and Pediatrics (Dr Bohan), and the Analytical Chemistry Center (Dr Lin), University of Texas Medical School Health Science Center, Houston.

Footnotes
Accepted for publication January 29, 1990.

Presented in part at the 114th annual meeting of the American Neurological Association, New Orleans, La, September 25, 1989.

Reprint requests to the Department of Neurology, University of Texas Medical School, 6431 Fannin #7.044, Houston, TX 77030 (Dr Willmore).

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