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Borbath and coworkers [82] reported the case of a 51-year-old woman who received 10 mg/kg VPA daily to prevent seizures after a neurosurgical procedure, and who developed VHE (ammonia concentration 234 mol/l) without any sign of hepatic dysfunction

The possible transport mechanisms together with the wide tissue distribution underlie the role of OCTN2 as the major transporter responsible for the traffic of carnitine and carnitine derivatives in the intestine, distribution to several body districts and reabsorption/excretion in the kidney (Figure 2)