SHM Converge Scientific Abstract ePoster Gallery-Don't Hate on Valproate; A Rare Case of Valproate-Induced Pancreatitis

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This case report describes a rare instance of valproic acid (VPA)-induced pancreatitis in a 49-year-old man with autism and epilepsy, who also had hypertension and hyperlipidemia. His VPA dose had recently been increased from 750 mg twice daily to 1000 mg twice daily one month before presentation. He came to the emergency department with lethargy and pallor but notably had no abdominal pain, fever, vomiting, diarrhea, or appetite changes.<br /><br />On exam, he was hypotensive but otherwise had no focal findings. Labs showed elevated AST, ALT, lactate, white blood cell count, and markedly elevated lipase (1306). Alcohol, triglycerides, and bilirubin were normal, abdominal ultrasound showed no gallstones, and IgG-4 was normal. CT imaging confirmed acute pancreatitis. He was treated with IV fluids, pain control, broad-spectrum antibiotics, and VPA was stopped. His VPA level was 60.8 mg/L, within the therapeutic range. He improved and was discharged to a skilled nursing facility.<br /><br />The discussion emphasizes that VPA-induced pancreatitis is uncommon but important to recognize, especially after recent treatment initiation or dose increases. The proposed mechanism is an idiosyncratic direct toxic effect causing free-radical-mediated cell membrane damage. Although rare, the condition can be serious, with reported mortality around 16% in one literature review. The authors conclude that clinicians should consider VPA as a possible cause of pancreatitis in patients taking the drug, particularly when GI symptoms or unexplained pancreatitis occurs.

Asset Subtitle

Zohaib Ahmad

Meta Tag

Author List Henri-Robert Delbeau, Isabelle Von-Ahlten, Jasbir Singh, Jonathan Ma, Leilah Tisheh, Lidia Castillo-Cruz, Mario Mekhail, Zohaib Ahmad

Category Clinical Vignettes

Concept Valproic acid

Concept Acute Pancreatitis

Concept Discontinuation

Concept Lipase

Concept Recent Therapy Initiation

Distinguished Non-Finalist

Presenter Organization NYU Langone Health Suffolk Hospital

Presenting Author Zohaib Ahmad

Track Adult

Keywords

valproic acid

pancreatitis

epilepsy

autism

dose increase

lipase elevation

acute pancreatitis

therapeutic drug level

drug-induced pancreatitis

case report

Valproic acid

Acute Pancreatitis

Discontinuation

Lipase

Recent Therapy Initiation