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The question whether GABA forming microbiota can alter plasma GABA is unresolved: two germ-free models employing metabolomics support this premise (97, 98) whereas another germ-free rodent study did not (99)

[17] Concomitant use of topiramate also increases the risk of hepatic encephalopathy by 2 mechanisms: By blocking carbonic anhydrase and producing a degree of metabolic acidosis, which shifts the ammonium ion equilibrium towards ammonia