Therapeutic and Toxic Effects of Valproic Acid Metabolites Valproic acid induced encephalopathy: A review of clinical features, risk factors, diagnosis, and treatment ScienceDirect L carnitine does not improve valproic acid poisoning management: a cohort study with toxicokinetics and concentration effect relationships Annals of Intensive Care Springer Nature Link Valproic Acid Toxicity When the calmer becomes the culprit In the ICU, some tox cases whisper and some unravel like a metabolic domino cascade. Valproate toxicity belongs to the latter.