Toxicology: valproate hyperammonaemia: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Toxicology: valproate hyperammonaemia

Sample item

A girl on sodium valproate takes an overdose and becomes drowsy. Liver enzymes are near normal but the arterial ammonia level is high. Which agent may be used to treat the hyperammonaemia?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Levocarnitine

Valproate causes carnitine deficiency and interferes with the urea cycle, resulting in hyperammonaemia. Levocarnitine supports mitochondrial fatty acid metabolism and ammonia handling, and dialysis is used in severe overdose. The other agents do not act on this pathway.

Option by option

  • A. Thiamine

    Thiamine is given in Wernicke's encephalopathy and does not treat valproate toxicity.

  • B. Levocarnitine (correct)

    Correct. Levocarnitine corrects the valproate-induced carnitine deficiency.

  • C. Fomepizole

    Fomepizole inhibits alcohol dehydrogenase in methanol or ethylene glycol poisoning.

  • D. Flumazenil

    Flumazenil reverses benzodiazepines.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is B, Levocarnitine. Valproate causes carnitine deficiency and interferes with the urea cycle, resulting in hyperammonaemia.

Why is "Thiamine" not the answer?

Thiamine is given in Wernicke's encephalopathy and does not treat valproate toxicity.

Why is "Fomepizole" not the answer?

Fomepizole inhibits alcohol dehydrogenase in methanol or ethylene glycol poisoning.

Why is "Flumazenil" not the answer?

Flumazenil reverses benzodiazepines.

What concept does this question test?

It tests Toxicology: valproate hyperammonaemia in Forensic Medicine. Levocarnitine supports mitochondrial fatty acid metabolism and ammonia handling, and dialysis is used in severe overdose. The other agents do not act on this pathway.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Toxicology: valproate hyperammonaemia?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.