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[Acute hepatic failure associated with valproic acid in children. Report of 3 cases]
S A Antoniuk1, I Bruck, L R Hönnicke
1Departamento de Pediatria da Universidade Federal do Paraná, Curitiba, Brasil.
Insights
Valproic acid can cause severe liver damage (hepatotoxicity) in epileptic children, especially those under two years old on multiple medications. While some cases are reversible, this serious side effect requires careful monitoring in pediatric epilepsy patients.
Area of Science:
- Pediatric Neurology
- Hepatology
- Clinical Toxicology
Background:
- Valproic acid is a common antiepileptic drug.
- Hepatotoxicity is a known, albeit rare, adverse effect of valproic acid.
- Pediatric patients, particularly those with developmental delay and on polytherapy, may be at higher risk.
Abstract:
We report the cases of three epileptic children who developed hepatotoxicity induced by valproic acid. Two patients had developmental delay. Including the one who died, all patients were receiving polytherapy (carbamazepine in two and phenobarbital in one). The patients age ranged from 2 years and 8 months to 5 years and 1 month. The onset of hepatic complications occurred within 6 months of valproate therapy in two patients and 12 months in one. All patients developed the classical clinical signs of hepatotoxicity. Vomiting, edema and jaundice were the initial symptoms. Fever occurred in two patients. The serum levels of glutamic oxaloacetic transaminase were mildly elevated with a maximum of 194 IU. The bilirubin levels ranged from 5.5 to 19.8 mg%. Two patients recovered clinically and showed normalization of the laboratory abnormalities and one had fatal course. The hepatotoxicity must be considered as a side effect of valproic acid mainly in children under two years age, with polytherapy regimen and neurologic damage. The hepatic insufficiency can be reversible.