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L-carnitine used to treat hyper-ammonia in children with urea-cycle enzyme deficiencies26 and valproate-induced hyper-ammonia.27 The protec tive effects of L-carnitine are centrally mediated by activation of metabotropic Glu receptors at the level of brain ammonia uptake and/or mitochondrial energy metabolism
They also control hunger signals between the stomach and the brain, which patients say quiets "food noise" or the amount of time they spend thinking about what they'd like to eat
GLP-1RA treatment also mitigates experimental diabetic cardiomyopathy by the indirect mechanisms of augmenting glucose oxidation in cardiomyocytes [84]
A multifaceted approach addressing nutrition, hydration, lifestyle, and medication management is most effective
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