Acute pancreatitis in children from Valproic acid: case series and review

Valproic acid (VPA) is a commonly prescribed medication approved for use in the United States for epilepsy, migraine, and bipolar disorder. Although the common adverse effects associated with VPA are typically benign, less common but more serious adverse effects can occur. These include hepatotoxicity, teratogenicity, possible polycystic ovaries with the potential for sterility or carcinogenesis, and pancreatitis. A characteristic clinical profile has been determined for several of these adverse effects. We report four children with VPA-induced pancreatitis, one of which was fatal, and review the literature. Three of these children presented within a 4-year period (1995-1999) at the same institution. Because previous reviews have included either a small number of patients, or both pediatric and adult patients, we reviewed only pediatric cases to minimize any effect from adults with more serious co-existing medical illnesses. We attempted to determine the following: (1) if there are any characteristics that are predictive of pancreatitis and whether it will be fatal; (2) whether different clinical and laboratory characteristics exist for nonfatal vs fatal cases; and (3) if a specific pediatric patient profile, similar to that with VPA associated hepatotoxity or polycystic ovary-androgenism syndrome, could be identified.