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TMAO promotes cardiac hypertrophy via elevated intracellular Ca2+ levels and enhanced autophagy-mediated degradation of SERCA2a.

Patients who develop symptoms of unexplained hyperammonemic encephalopathy while receiving valproate therapy should receive prompt treatment (including discontinuation of valproate therapy) and be evaluated for underlying urea cycle disorders (see Contraindications and Hyperammonemia and Encephalopathy Associated with Concomitant Topiramate Use as follows)

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