Acute pancreatitis during valproic acid administration in a patient with vascular dementia, epileptic seizures, and psychiatric symptoms: a case report

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Valproic acid (VPA) is a relatively safe drug widely used for the treatment of epileptic seizures and mania in bipolar disorder, as well as the prevention of migraine headaches. Here, we present a case of VPA-induced pancreatitis in a patient with vascular dementia, epileptic seizures, and psychiatric symptoms. He had no distinctive abdominal symptoms.

Case presentation

A 66-year-old Japanese man was treated with VPA for agitation and violent behavior due to vascular dementia, epileptic seizures, and psychiatric symptoms. During admission, he experienced a sudden decrease in consciousness and blood pressure. Abdominal findings were unremarkable; however, blood tests showed an inflammatory response and elevated amylase levels. Contrast-enhanced abdominal computed tomography showed diffuse pancreatic enlargement and inflammation extending to the subrenal pole. VPA-induced acute pancreatitis was diagnosed, VPA was discontinued, and high-dose infusions were administered. Acute pancreatitis resolved after treatment initiation.

Conclusions

Clinicians should be aware of this relatively rare side effect of VPA. Diagnosis may be challenging in elderly people and patients with dementia as they may present with non-specific symptoms. Clinicians should consider the risk of acute pancreatitis when using VPA in patients who cannot report spontaneous symptoms. Blood amylase and other parameters should be measured accordingly.

Related collections

Most cited references 12

Record: found
Abstract: found
Article: not found

Drug-induced acute pancreatitis: an evidence-based review.

Marcos W. Steinberg, Jianjun Li, Nison Badalov … (2007)

The diagnosis of drug-induced acute pancreatitis often is difficult to establish. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. In addition, some medications reported to have caused acute pancreatitis have obvious patterns of presentation, including the time from initiation to the development of disease (latency). There also appear to be patterns in the severity of disease. After reviewing the literature, we have classified drugs that have been reported to cause acute pancreatitis based on the published weight of evidence for each agent and the pattern of clinical presentation. Based on our analysis of the level of evidence, 4 classes of drugs could be identified. Class I drugs include medications in which at least 1 case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class II drugs include drugs in which there is a consistent latency in 75% or more of the reported cases. Class III drugs include drugs that had 2 or more case reports published, but neither a rechallenge nor a consistent latency period. Class IV drugs were similar to class III drugs, but only 1 case report had been published. Our analysis allows an evidence-based approach when suspecting a drug as causing acute pancreatitis.

0 comments Cited 72 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Acute Pancreatitis: Diagnosis and Treatment

Peter Szatmary, Tassos Grammatikopoulos, Wenhao Cai … (2022)

Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.

0 comments Cited 49 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Drug-induced acute pancreatitis: a review.

Mark Jones, Oliver Morgan Hall, Adam Kaye … (2015)

The majority of drug-induced pancreatitis cases are mild to moderate in severity, but severe and even fatal cases can occur. Management of drug-induced pancreatitis requires withdrawal of the offending agent and supportive care.

0 comments Cited 48 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Naomichi Okamoto:

ORCID: http://orcid.org/0000-0003-2791-8113

nokamoto@med.uoeh-u.ac.jp

Journal

Journal ID (nlm-ta): J Med Case Rep

Journal ID (iso-abbrev): J Med Case Rep

Title: Journal of Medical Case Reports

Publisher: BioMed Central (London )

ISSN (Electronic): 1752-1947

Publication date (Electronic): 29 May 2023

Publication date PMC-release: 29 May 2023

Publication date Collection: 2023

Volume: 17

Electronic Location Identifier: 221

Affiliations

[1 ]GRID grid.271052.3, ISNI 0000 0004 0374 5913, Department of Psychiatry, , University of Occupational and Environmental Health, ; Fukuoka, 8078555 Japan

[2 ]GRID grid.271052.3, ISNI 0000 0004 0374 5913, Medical Center for Dementia, , Hospital of the University of Occupational and Environmental Health, ; Fukuoka, 8078555 Japan

[3 ]GRID grid.271052.3, ISNI 0000 0004 0374 5913, Third Department of Internal Medicine, , University of Occupational and Environmental Health, ; Fukuoka, 8078555 Japan

Author information

Naomichi Okamoto http://orcid.org/0000-0003-2791-8113

Article

Publisher ID: 3964

DOI: 10.1186/s13256-023-03964-4

PMC ID: 10226237

PubMed ID: 37246215

SO-VID: 1b4f0a52-4b38-4154-8f2e-390dbcdabf4b

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 18 August 2022

Date accepted : 1 May 2023

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: valproic acid,acute pancreatitis,vascular dementia,symptomatic epilepsy,psychiatric symptoms

Data availability:

ScienceOpen disciplines: Medicine

Keywords: valproic acid, acute pancreatitis, vascular dementia, symptomatic epilepsy, psychiatric symptoms

Acute pancreatitis during valproic acid administration in a patient with vascular dementia, epileptic seizures, and psychiatric symptoms: a case report

Read this article at

Abstract

Background

Case presentation

Conclusions

Related collections

Vascular Biology

Most cited references 12

Drug-induced acute pancreatitis: an evidence-based review.

Acute Pancreatitis: Diagnosis and Treatment

Drug-induced acute pancreatitis: a review.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 548

Most referenced authors 131