Acute pancreatitis and hyperammonemia in a hemodialysis patient during valproic acid therapy: A case report.

Kamijo, Toshio; Sato, Toshikazu; Yanagizawa, Ryozo; Kishi, Hiroichi

doi:10.4009/jsdt.27.53

Cited by 1 publication

(3 citation statements)

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“…Ng et al reported a female patient with epilepsy who was administered VPA and developed pancreatitis during hemodialysis [ 7 ]. Since then, the similar types of cases that have been reported thus far were cases with epilepsy [ 1 , 8 - 10 ]. To the best of our knowledge, the present report is the first case of VPA-induced pancreatitis in a patient with bipolar disorder who was also undergoing hemodialysis.…”

Section: Case Presentationmentioning

confidence: 86%

“…VPA is primarily metabolized as a glucuronic acid-conjugated compound [10]; however, several types of intermediate metabolites other than the glucuronic acid-conjugated compound are found in normal human urine. One possible etiology is that patients with renal failure are prone to pancreatitis because these intermediate metabolites accumulate due to renal failure leading to pancreatic cell damage.…”

Section: Discussionmentioning

confidence: 99%

“…Torelli et al reported that the intermediate metabolites of VPA have toxic effects on pancreatic cells, and this is believed to be the main cause of VPA-induced pancreatitis [ 11 ], although the definite metabolite has not been revealed yet. VPA is primarily metabolized as a glucuronic acid-conjugated compound [ 10 ]; however, several types of intermediate metabolites other than the glucuronic acid-conjugated compound are found in normal human urine. One possible etiology is that patients with renal failure are prone to pancreatitis because these intermediate metabolites accumulate due to renal failure leading to pancreatic cell damage.…”

Section: Case Presentationmentioning

confidence: 99%

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Development of acute pancreatitis caused by sodium valproate in a patient with bipolar disorder on hemodialysis for chronic renal failure: a case report

et al. 2014

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BackgroundCases of acute pancreatitis caused by sodium valproate (VPA) have been reported by many authors thus far. However, most of these were cases with epilepsy. Chronic renal failure is also regarded as a risk factor for acute pancreatitis. Here, we report a case of acute pancreatitis development due to VPA in a patient with bipolar disorder on hemodialysis for chronic renal failure.Case presentationThe patient was a 52-year-old Japanese male who was diagnosed as bipolar disorder on hemodialysis for renal failure. He was treated with VPA and manic symptoms gradually stabilized. However, the patient complained of severe abdominal pain. Blood amylase was found to be markedly high, and computed tomography revealed pancreatomegaly and an increased amount of peripancreatic fat. Hence, we diagnosed the case as acute pancreatitis caused by VPA. We discontinued oral medication, and he was started on a pancreatic enzyme inhibitor, antibiotics, and transfusion, and he showed improvement.ConclusionIt has been reported that acute pancreatitis induced by VPA is caused by intermediate metabolites of VPA. We consider that patients with renal failure are prone to pancreatitis caused by VPA because of the accumulation of these intermediate metabolites. We need close monitoring for serious adverse effects such as pancreatitis when we prescribe VPA to patients with bipolar disorder on hemodialysis for chronic renal failure, although VPA is safer than other mood stabilizers.

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Section: Case Presentationmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

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