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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]

If persistent diarrhea or ongoing vomiting is making it impossible to maintain adequate hydration despite your best efforts, discuss dose adjustment with your prescribing physician

Engebretsen, Iris Kliers, Laura stergaard, Denise Vanni are employees and stockholders of Novo Nordisk A/S

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Comment: Some commenters agreed that the term upstream drivers encompasses a wider range of root causes of the problems that practitioners are addressing through CHI services, such as potential dietary, behavioral, medical, and environmental drivers to lessen the impacts of the problem(s) addressed in the initiating visit

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