The Spectrum of Valproic Acid–Associated Pancreatitis

Abstract

Valproic acid-associated pancreatitis does not depend on valproic acid serum level and may occur any time after the onset of therapy. The serum lipase level is more sensitive than the serum amylase level and should be obtained when pancreatitis is suspected. Early imaging studies did not change clinical management. Rechallenge with valproic acid is dangerous and should be avoided.

Valproic acid-induced acute pancreatitis in pediatric age: case series and review of literature

“…As is known the causes of AP in pediatric age are different from those of adult: biliary-pancreatic anomalies, trauma, systemic disease, viral infections and drug toxicity (3).The AP, because its potential gravity with considerable morbidity and mortality, requires proper definition of diagnosis as well as a specialized multidisciplinary approach. In the literature are reported about 500 drugs liable of the onset of AP.…”

Acute pancreatitis associated to the use of valproic acid

“…Abdominal pain is the most frequent symptom of acute pancreatitis, and it occurs in more than 80% of patients localized in the epigastrium, as happened with our patient. It can also be accompanied by nausea and vomiting in 70%, abdominal distension in 30%, and fever in 26% of the cases described 15 . There are no reliable and sensible clinical criteria to objectively assess the gravity and the prognosis in children 20 .…”

“…The determination of blood amylase and lipase levels is fundamental, as their increase helps to orient us and may confirm the clinical suspicion. Amylase levels may increase in some patients receiving valproic acid without turning into pancreatitis 15 . In a patient receiving valproic acid, a diagnosis of pancreatitis must be established with increased levels of pancreatic enzymes together with the presence of clinical symptoms.…”

Valproic Acid Induced Acute Pancreatitis – A case report

“…But this mitochondrial b-oxidation enzyme deficient theory was challenged by other workers who did not find any change in amino acid levels responsible for VPA induced pancreatitis 9 . The diagnosis of pancreatitis is made on clinical findings 10 as well as increase in serum amylase and lipase values 11 . Abdominal ultrasound is useful in the preliminary evaluation of patients suspected of having acute pancreatitis and it should be done in the first 24-48 hours from the onset of the clinical symptoms 12 as was done in the present case.…”