Acute Hepatitis induced by prolonged use of Sodium Valproate

She has developed jaundice for the last 7 days. She is 4 and 7 months of age. No other complaints. No fever, no nausea or vomiting. even no abdominal pain, only anorexia.
But she was taking Sodium Valproate (Sup Valex) for the last 4 years. She was given this drug after convulsions at the age of 6 months. Since then she had no further convulsion and continued to take the medicine till date. She was vaccinated in infancy against Hepatitis B.

On examination, the patient was found moderately icteric.Liver was enlarged 8 cm, mildly tender. Other systems were normal.

Serum bilirubin was found 5.3 mg/dl, SGPT 535 IU/dl, Alkaline phosphatase 1388 IU/dl. Her HBsAg was found negative, prothrombin time normal.
Ultrasonography was consistent with Acute inflammation of the liver.

We conclude this could be a case of Acute Hepatitis induced by prolonged use of Sodium Valproate.
We withdrew the drug.,admit the patient in the hospital for better observation.
Patient was gradually improving. After 7 days, we repeat the Liver Function test. The Serum bilirubin come down to 1.3 mg/dl, SGOT 57 IU/dl, Alkaline Phosphatase 103 IU/dl.

Patient was discharged with advice to come after 7 days for follow up.


Bdoza