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Answer and interpretation L-carnitine supplementation Treatment involving L-carnitine supplementation to correct carnitine deficiency might help prevent the accumulation of ammonia Evidence consists largely of case reports and retrospective case series demonstrating benefits with L-carnitine use Further research is needed to better define its role and regime of use in VPA toxicity (Lheureux and Hantson, 2009) Haemodialysis reported as a treatment used in VHE, but clear benefit is yet to be established RRT may be of benefit early in very large ingestions with high VPA levels to reduce the incidence of neurotoxic effects, through enhanced clearance of VPA and possibly via the enhanced clearance of ammonia (Thanacoody, 2009) Licari et al (2009) describes two approaches to the treatment of two almost identical presentations of VPA overdose, both of which ingested 16g, and were haemodynamically stable throughout admission 10: Patient 1: Peak level 595mg/L, intubated and ventilated, and managed conservatively with no RRT

Lysine 27 ubiquitination of the mitochondrial transport protein Miro is dependent on Serine 65 of the parkin ubiquitin ligase

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