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

Choroid Plexus Papilloma with hydrocephalus and loss of speech

A boy of 9 years was suffering from seizure disorder for the last 5 years. He had occassional vomiting and headache for the last eight months. He lost his speech since one week.
On examination he was found to have hemipresis on the right side and facial palsy on the left side.
He was on Sodium valproate for convulsion.

CT scan shows Choroid Plexus Papilloma with hydrocephalus. Other tests -Blood CBC, Renal function and liver function are normal.

The patient was refered to the Neurosurgery Department for surgical management.




The patei