Pancreatitis with normal serum amylase associated with sodium valproate: a case report

The patient was a 1-year-old infant with severe postencephalitis syndrome. Diarrhea and elevation of the pancreatic enzymes, except for serum amylase (elastase 1 > 1, 5000 ng/dl (100–400); lipase, 885 IU/l/37° C (10–48); trypsin, > 900 ng/ml (110–460)), were observed starting 70 days after starting valproate (dose, 70 mg/kg; serum level, 83.8 μg/ml). These findings as well as those obtained by abdominal ultrasonography suggested a diagnosis of pancreatitis, which was thought to be caused by sodium valproate. Important signs of valproate-induced pancreatitis may be easily overlooked in patients with neurological impairment, such as in ours. Because the blood half-life of amylase is short, not only amylase but some other pancreatic enzymes should be promptly investigated when valproate-related pancreatitis is clinically suspected in physically or mentally handicapped children.