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Valproate-induced hyperammonaemic encephalopathy In chronic VPA dosing hyperammonaemia occurs in nearly 50% of patients, but this remains asymptomatic in almost 50% of cases [39]
Strong family history of hormone-sensitive cancers or genetic predisposition (BRCA1/2, Lynch syndrome): Elevated IGF-1 carries meaningful epidemiological risk that outweighs potential benefit without oncology clearance
aspiration is typically not required for subcutaneous injections
Though there is some conflicting research on this topic, given the other potential health benefits and safety profile of carnitine, a woman might want to discuss the use of carnitine with her doctor as a treatment option should she have a preterm infant
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