Okayasu Hiroaki, Shinozaki Takahiro, Osone Akira, Ozeki Yuji, Shimoda Kazutaka
Department of Psychiatry, Dokkyo Medical University, Mibu, Tochigi, Japan.
BMC Psychiatry. 2014 Mar 29;14:93. doi: 10.1186/1471-244X-14-93.
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.
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.
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.
迄今为止，许多作者都报道过丙戊酸钠（VPA）引发急性胰腺炎的病例。然而，其中大多数是癫痫患者。慢性肾衰竭也被视为急性胰腺炎的一个风险因素。在此，我们报告一例因VPA导致急性胰腺炎的病例，该患者为一名患有双相情感障碍且因慢性肾衰竭接受血液透析的患者。
患者为一名52岁的日本男性，被诊断为因肾衰竭接受血液透析的双相情感障碍患者。他接受VPA治疗，躁狂症状逐渐稳定。然而，患者主诉严重腹痛。发现血淀粉酶显著升高，计算机断层扫描显示胰腺肿大且胰腺周围脂肪量增加。因此，我们将该病例诊断为VPA所致急性胰腺炎。我们停用了口服药物，并开始给予胰腺酶抑制剂、抗生素和输血治疗，患者病情有所改善。
据报道，VPA诱发的急性胰腺炎是由VPA的中间代谢产物引起的。我们认为，肾衰竭患者因这些中间代谢产物的蓄积而更容易发生VPA所致胰腺炎。当我们给因慢性肾衰竭接受血液透析的双相情感障碍患者开具VPA时，尽管VPA比其他情绪稳定剂更安全，但我们仍需要密切监测胰腺炎等严重不良反应。
