Fanconi syndrome caused by sodium valproate: report of three severely disabled children

Area of Science:

• Pediatric Nephrology
• Clinical Neurology
• Pharmacovigilance

Background:

• Epilepsy management often involves sodium valproate, a widely used anticonvulsant medication.
• Severe developmental disabilities can complicate medical management and increase vulnerability to adverse drug reactions.
• Fanconi syndrome, a generalized proximal renal tubulopathy, can lead to significant electrolyte and metabolic disturbances.

Observation:

• Three severely disabled children with epilepsy, aged 4, 8, and 14 years, developed Fanconi syndrome.
• These children had been treated with sodium valproate from early infancy or childhood.
• All patients were bed-ridden and required nutritional support via nasogastric or gastrostomy tubes.

Findings:

• Sodium valproate was identified as the likely cause of Fanconi syndrome in these patients.
• Discontinuation of sodium valproate led to improvement in renal involvement within 2 to 12 months.
• This case series highlights a rare but serious adverse effect of sodium valproate therapy.

Implications:

• Severely handicapped children may be at increased risk for sodium valproate-induced renal complications.
• Clinicians should maintain a high index of suspicion for Fanconi syndrome in epileptic children on sodium valproate, particularly those with severe disabilities.
• Monitoring renal function is crucial in this vulnerable patient population to ensure timely diagnosis and management of adverse effects.