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67 The role of acetyl-L-carnitine in the treatment of HE is postulated to be related to reduction of serum ammonia by increasing ureagenesis 67 in addition to enhancing the production of acetylcholine in the brain (by facilitating the uptake of acetyl-coenzyme A) and stimulating protein and phospholipid synthesis, all of which increase cellular energy production and reduce neuronal toxicity in patients with HE