Abstract
A case of acute pancreatitis and hyperammonemia in a hemodialysis patient during sodium valproate (VPA) therapy is reported.
A 29-year-old woman on long-term hemodialysis, taking anticonvulsants including VPA, visited us for abdominal pain, nausea and vomiting. Laboratory data showed hyperamylasenemia, and X-ray revealed swelling of the pancreas and paralytic ileus. Under a diagnosis of acute pancreatitis, administration of VPA was stopped, and successful conservative therapy was performed. The administration of VPA was resumed. After two months, abdominal pain repeated. As gastrofiberscopy revealed esophagitis and gastric erosion, intravenous nutrition involving essential amino acids was injected. Suddenly the patient suffered coma as a result of hyperammonemia. Administration of VPA was stopped immediately, and following administration of branched chain amino acids and hemodialysis, consciousness disturbance was recovered. After changing anticonvulsants, there was no evidence of these episodes.
Acute pancreatitis and coma caused by hyperammonemia were suspected as side effects of VPA. The side effects of VPA are discussed and reviewed.
