In overdose and therapeutic ingestions can cause hepatic enzyme elevation (idiosyncratic) but can also cause hyperammonemia without hepatic enyme elevation
Have a patient with somnolence or altered mental status and is on valproic acid - check a level but also check an ammonia level
Elevated ammonia levels can be treated with an antidote - carnitine (IV or PO)
Very safe antidote (carnitine) since it is a nutritional supplement, consider in patients on valproic acid and decreased responsivness with elevated ammonia
