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The position statements of the American Academy of Clinical Toxicology (AACT) suggests the following when applied to large VPA overdose (ref 12 to 14) SDAC Should not be administered as a routine intervention It can be considered up to an hour post ingestion (4 hours in slow or enteric release preparations) in those who have ingested potentially toxic dose, and who have an intact, protected airway Usual dose is 1gm/kg MDAC Reported to be used in multiple cases of VPA overdose, but AACT position statement states that there is no evidence that MDAC increases the elimination of VPA, and should only be considered in specific overdoses (carbemazepine, dapsone, phenobarbitone, quinine, or theophylline) it may aid decontamination (rather than enhanced elimination) given the slow absorption of valproate WBI consider in sustained release or enteric-coated ingestions that are potentially toxic or life threatening in patients presenting greater than two hours

Biochem J 1975

PDHC, Pyruvate dehydrogenase complex

Journal of the American College of Nutrition , 18, 1, 01-02-1999, p

The most abundant species traced during advanced fibrosis are E.coli and Bacteroides vulgatus (79)

Sci Rep (2019) 9:11647