Valproate-induced coma with ketosis and carnitine insufficiency
W. J. Triggs, T. P. Bohan, S. N. Lin and L. J. Willmore
Department of Neurology, University of Texas Medical School Health Science Center, Houston.
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.
