title: Development of acute pancreatitis caused by sodium valproate in a patient with bipolar disorder on hemodialysis for chronic renal failure: a case report.
abstract: BACKGROUND
  Cases 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.
  
  
  METHODS
  The 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.
  
  
  CONCLUSIONS
  It 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.
authors.affiliation: Department of Psychiatry, Dokkyo Medical University, Mibu, Tochigi, Japan. hokayasu@dokkyomed.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okayasu
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shinozaki
authors.forename: Akira
authors.initials: A
authors.lastname: Osone
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ozeki
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Shimoda
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010195:Pancreatitis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011859:Radiography; D006435:Renal Dialysis; D012307:Risk Factors; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid