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10.1016/j.ajem.2004.06.001 Sztajnkrycer MD: Valproic acid toxicity: overview and management

The goal is to let the hypothalamic-pituitary axis adjust gradually

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6.6 When to Refer Referral to a clinician or dietitian may be appropriate when: Persistent GI intolerance limits intake Weight loss exceeds 20% body weight Multiple laboratory abnormalities are present Underlying malabsorptive or gastrointestinal disease exists Patient is elderly or medically complex GLP-1 therapy should not occur in isolation from nutritional oversight when risk factors are present

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Accountability is key