Acute liver failure with thrombotic microangiopathy due to sodium valproate toxicity: A case report

Abstract

BACKGROUND Sodium valproate is widely used in the treatment of epilepsy in clinical practice. Most adverse reactions to sodium valproate are mild and reversible, while serious idiosyncratic side effects are becoming apparent, particularly hepatotoxicity. Herein, we report a case of fatal acute liver failure (ALF) with thrombotic microangiopathy (TMA) caused by treatment with sodium valproate in a patient following surgery for meningioma. CASE SUMMARY A 42-year-old man who received antiepileptic treatment with sodium valproate after surgery for meningioma exhibited extreme fatigue, severe jaundice accompanied by oliguria, soy sauce-colored urine, and ecchymosis. His postoperative laboratory values indicated a rapid decreased platelet count and hemoglobin level, severe liver and kidney dysfunction, and disturbance of the coagulation system. He was diagnosed with drug-induced liver failure combined with TMA. After plasma exchange combined with hemoperfusion, pulse therapy with high-dose methylprednisolone, and blood transfusion, his liver function deteriorated, and finally, he died. CONCLUSION ALF with TMA is a rare and fatal adverse reaction of sodium valproate which needs to be highly valued.

Syringic acid and silymarin concurrent administration inhibits sodium valproate‐induced liver injury in rats

“…Sodium valproate (2‐propylpentanoic acid; SV) is commonly used to control epilepsy, bipolar disorders, and migraines 6 . SV causes acute liver injury resulting in acute liver failure with thrombotic microangiopathy, hepatic encephalopathy in clinical subjects 7–9 . In experimental studies, SV has been reported to elevate liver marker enzymes in serum and induce oxidative stress mediated liver injury in rats 10,11 .…”

Sıçanlarda Sodyum Valproat ile İndüklenen Dalak Toksisitesinde Rutinin Antioksidan, Antiinflamatuvar ve Antiapoptotik Etkileri

“…VPA toxicity can occur with dose adjustments to reach therapeutic levels in patients with metabolic disorders, drug-drug interactions, or self-harm attempts [6]. Its toxic effects are seen in multiple organ systems such as the hematological, nervous, and digestive systems [7]. Long-term use of VPA may cause nausea, vomiting, anorexia, sedation, weight gain, hair loss, hepatotoxicity, encephalopathy, and myopathy [8].…”