title: Hepatic Dysfunction as a Complication of Combined Valproate and Ketogenic Diet.
abstract: BACKGROUND
  The ketogenic diet has long been shown to be an effective therapy for children with medication-refractory seizures. Most complications of the ketogenic diet include short-lived gastrointestinal disturbances, acidosis, and dyslipidemia. Hepatic dysfunction and pancreatitis are among the less common but more serious complications of the ketogenic diet. Many patients on the ketogenic diet receive adjunct treatment with an anticonvulsant drug, and valproate is frequently used.
  
  
  RESULTS
  We describe a child who developed hepatic dysfunction in association with the combined use of valproate and the ketogenic diet. After stopping the valproate and then restarting the ketogenic diet, her liver enzymes normalized, and she was able to achieve markedly improved seizure control and quality of life.
  
  
  CONCLUSIONS
  Although caution should be advised when using both treatments simultaneously, the development of hepatic dysfunction should not preclude continuation of the ketogenic diet, as the hepatotoxic effects may be completely reversed once the valproate is stopped.
authors.affiliation: Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Stevens
authors.affiliation: Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Zahava
authors.initials: Z
authors.lastname: Turner
authors.affiliation: Departments of Pediatrics and Neurology, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: ekossoff@jhmi.edu.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D055423:Diet, Ketogenic / Q000009:adverse effects*; D000069279:Drug Resistant Epilepsy / Q000201:enzymology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D065768:Lennox Gastaut Syndrome / Q000201:enzymology / Q000628:therapy; D008107:Liver Diseases / Q000201:enzymology / Q000209:etiology*; D019233:Retreatment; D016896:Treatment Outcome; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid
keywords: complications; epilepsy; hepatitis; ketosis; liver; side effects; valproic acid