Abstracts

RATIONALE: In the past 6 years, 10 children on valproic acid have developed pancreatitis in the authors[ssquote] children[ssquote]s hospital. Nine of the cases occurred within the past 4 years. Valproic Acid has been used as one of the primary anticonvulsants for generalized seizures in children for the past 25 years. A literature review reveals mostly singular reports over the past decade.
METHODS: The charts of the 10 patients with presumed valproic acid induced pancreatitis were reviewed. Dosage, valproic acid serum levels, duration of therapy and concomitant medications were examined. Families were contacted by phone to determine the formulation (brand name vs. generic) of valproic acid at the time of diagnosis.
RESULTS: No association was found between the above stipulated factors. Six girls and 4 boys were diagnosed. The ages ranged from 4-16 years. Eight out of 10 presented with an acute abdomen. Unexpectedly, 2 presented with a flu-like illness. Serum lipase values ranged from 341 to 5576 (normal range [lt] 190 U/L). Dosage ranged from 20 mg/kg to 50 mg/kg. Serum levels ranged from 334 umol/L to 884 umol/L (therapeutic range 350-800 umol/L). Five of the patients were on monotherapy. Five children were on brand name drug. Only 3 of the 10 had a neurological syndromic diagnosis (West[ssquote]s, Rett and Lowe syndrome). Five of the children had a history of drug allergies. Valproic acid was reintroduced in one child and resulted in a second episode of pancreatitis.
CONCLUSIONS: We propose that pancreatitis is a severe adverse effect of valproic acid. Duration of the treatment, serum valproic acid levels, generic preparation or the presence of concomitant antiepileptic drugs did not appear to be risk factors. Children with known drug sensitivity may be at risk. Lipase levels at the time of flu-like illness in epileptic children taking valproic acid may reveal early stages of pancreatitis and are strongly recommended.