VALPROIC ACID HEPATIC FATALITIES .3. US EXPERIENCE SINCE 1986

We report the results of a third retrospective study of the U.S. exper ience with fatal hepatotoxicity associated with valproic acid (VPA). I n the United States, over one million patients received new prescripti ons for VPA during the years 1987 to 1993, and 29 patients developed f atal hepatotoxicity. Decreased alertness, jaundice, vomiting, hemorrha ge, increased seizures, anorexia, and edema were the most common prese nting signs. Risk factors included young. age, polytherapy, developmen tal delay, and coincident metabolic disorders. Patients less than 2 ye ars old receiving VPA as polytherapy were at the greatest risk (1:600) of developing this complication.