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Microvascular thrombosis impairs oxygen exchange, and widespread cellular hypoxia may contribute to LC symptoms such as sleep disturbances, anxiety, and depression (67, 68)

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Methylation Deficiency Impaired detoxification of estrogens, toxins, and neurotransmitters

Although -oxidation is impaired in the setting of VPA toxicity, this metabolite has a prolonged elimination half-life and could be responsible for the prolonged coma that is sometimes observed despite the normalization in plasma VPA concentrations [17, 18]

Metabolic effects of l-carnitine on type 2 diabetes mellitus: systematic review and meta-analysis