SHM Converge Scientific Abstract ePoster Gallery-Fatal Valproic Acid-Induced Acute Necrotizing Pancreatitis in Healthy Adolescent

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This case describes a 19-year-old male with juvenile myoclonic epilepsy who was transferred with severe acute necrotizing pancreatitis, ultimately attributed to valproic acid. He was taking valproic acid, lacosamide, and topiramate, and presented lethargic with mild diffuse abdominal tenderness. On arrival, he was profoundly hypovolemic and hypotensive, requiring aggressive IV fluids and vasopressors.<br /><br />Laboratory findings showed marked critical illness, including lactic acidosis, severe thrombocytopenia, hypofibrinogenemia, hyperbilirubinemia, elevated AST/ALT, and mildly elevated ammonia. His valproic acid level was not markedly elevated. Imaging demonstrated severe necrotizing pancreatitis with large-volume ascites, subocclusive splenic vein thrombosis, and bilateral renal infarcts. No structural, infectious, metabolic, or other toxic cause for pancreatitis was identified.<br /><br />Despite supportive care and antibiotics, he developed multiorgan dysfunction syndrome. This progressed to acute renal failure requiring continuous renal replacement therapy, followed by acute liver and pancreatic failure. Liver failure caused significant coagulopathy requiring multiple blood products, while pancreatic insufficiency led to highly labile blood glucose. He also developed abdominal compartment syndrome, managed conservatively with a peritoneal drain and nasogastric decompression. Unfortunately, he later suffered ventricular fibrillation progressing to pulseless electrical activity, and resuscitation efforts were unsuccessful.<br /><br />The report emphasizes that valproic acid is a known but rare cause of pancreatitis, with adverse effects including hyperammonemic encephalopathy, hepatitis, and pancreatitis. Valproic-acid–associated pancreatitis is not clearly dose dependent, and the mechanism is poorly understood, though oxidative injury has been proposed. The incidence appears higher in children and adolescents.

Asset Subtitle

Florent Sherifi

Meta Tag

Author List Florent Sherifi, Marc Roberge, Salahuddin Nasir

Category Clinical Vignettes

Concept Valproic acid

Concept Necrotizing Pancreatitis

Concept Acute Pancreatitis

Concept Drug-Induced Pancreatitis

Concept Shock

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Florent Sherifi

Track Adult

Keywords

valproic acid

necrotizing pancreatitis

juvenile myoclonic epilepsy

multiorgan dysfunction syndrome

acute renal failure

liver failure

abdominal compartment syndrome

thrombocytopenia

hyperammonemia

splenic vein thrombosis

Valproic acid

Necrotizing Pancreatitis

Acute Pancreatitis

Drug-Induced Pancreatitis

Shock