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Center S, Harte J, Watrous D, et al

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[2] [11] This reduces the risk of hypoglycaemia compared to some other diabetes medications, though this risk can increase when combined with insulin or sulfonylureas

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additional potential treatments for hyperammonemia hyperammonemia physiology Mechanisms of ammonia elevation: (1) Valproic acid and metabolites (especially propionic acid) inhibit the activity of N-acetylglutamate synthetase (NAGS)

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The key is having a clinician experienced with pediatric obesity guiding that decision, rather than extrapolating from adult guidelines

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