ABSTRACT:
Background: Valproic acid (VPA) is an anticonvulsant drug used for seizures, bipolar disorder, and migraines. Therapeutic levels range from 50-100 μg/mL, with higher levels causing adverse effects like coagulopathies. VPA can cause thrombocytopenia, platelet dysfunction, acquired von Willebrand disease, and other bleeding disorders. These complications are rarely fatal but are more common in children. This case report examines VPA-induced coagulopathy resulting in mortality in a pediatric burn patient.
Case Presentation: A 16-year-old female with a history of seizures presented with 10% total body surface area superficial partial thickness scald burns to her face, neck and chest. She was started on intravenous VPA for seizure prophylaxis. On hospital day 8 she developed severe gastrointestinal bleeding unresponsive to resuscitation attempts and died due to hemorrhagic shock on day 10. Extensive workup excluded other etiologies like inherited coagulopathies, dengue fever, sepsis, and medications. Falling platelet counts, albumin, lymphocyte and hemoglobin levels were noted with elevated d-dimers, pointing to a VPA-induced bone marrow suppression and platelet dysfunction.
Conclusion: This case demonstrates the potential for fatal bleeding complications with short-term VPA use even at therapeutic doses. It highlights the need for close monitoring of hematologic parameters and maintaining a low threshold for changing anticonvulsant therapy in vulnerable patient populations.
Key words: Key Words: Valproic acid, coagulopathy, thrombocytopenia, platelet dysfunction, hemorrhage, burn
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