{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:14:58Z","timestamp":1792800898302,"version":"4.5.0"},"reference-count":14,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,2]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>We present a case of a man in his late 20s with psychiatric and metabolic comorbidities who developed acute necrotising pancreatitis in the setting of antiepileptic polypharmacy, including valproic acid. The patient presented with nausea, vomiting and progressive lethargy without the classic abdominal pain of pancreatitis, which contributed to diagnostic delay. He rapidly deteriorated into multiorgan failure and septic shock. Laboratory evaluation demonstrated markedly elevated lipase at 16\u2009310\u2009U\/L, leucocytosis, metabolic acidosis, acute kidney injury and lactic acidosis. Serum triglycerides, calcium and glucose were within normal limits, excluding metabolic causes. Imaging confirmed necrotising pancreatitis with a large peripancreatic fluid collection. Following exclusion of alternative aetiologies, valproic acid was identified as the most likely cause. The patient improved with supportive management. This case underscores that valproic acid can cause life-threatening pancreatitis even at therapeutic levels and highlights the importance of reviewing medications, particularly in cases presenting atypically without abdominal pain.<\/jats:p>","DOI":"10.1136\/bcr-2026-274799","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:45:19Z","timestamp":1790772319000},"page":"e274799","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["When seizure control comes at a cost: valproic acid-induced necrotising pancreatitis in a patient receiving antiepileptic polypharmacy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0334-5437","authenticated-orcid":false,"given":"Zoe Elizabeth","family":"Peltz","sequence":"first","affiliation":[{"name":"St Joseph\u2019s Medical Center Stockton, Stockton, California, USA"},{"name":"Touro University California, Vallejo, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4343-5029","authenticated-orcid":false,"given":"Areeba","family":"Ahmed","sequence":"additional","affiliation":[{"name":"St Joseph\u2019s Medical Center Stockton, Stockton, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanadi","family":"Abou Dargham","sequence":"additional","affiliation":[{"name":"St Joseph\u2019s Medical Center Stockton, Stockton, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"2026093005450950000_19.9.e274799.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejim.2024.10.030","article-title":"Practical management of severe acute pancreatitis","volume":"133","author":"Hamesch","year":"2025","journal-title":"Eur J Intern Med"},{"key":"2026093005450950000_19.9.e274799.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0231883","article-title":"Drug induced pancreatitis: A systematic review of case reports to determine potential drug associations","volume":"15","author":"Wolfe","year":"2020","journal-title":"PLoS One"},{"key":"2026093005450950000_19.9.e274799.3","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s00535-006-1961-4","article-title":"Valproic acid-induced pancreatitis: 16 new cases and a review of the literature","volume":"42","author":"Gerstner","year":"2007","journal-title":"J Gastroenterol"},{"key":"2026093005450950000_19.9.e274799.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1527-3458.2003.tb00249.x"},{"key":"2026093005450950000_19.9.e274799.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2010.02.002"},{"key":"2026093005450950000_19.9.e274799.6","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2008.152702"},{"key":"2026093005450950000_19.9.e274799.7","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1093\/gastro\/gox029","article-title":"A comparison of APACHE II, BISAP, Ranson\u2019s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification","volume":"6","author":"Harshit Kumar","year":"2018","journal-title":"Gastroenterol Rep (Oxf)"},{"key":"2026093005450950000_19.9.e274799.8","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002645"},{"key":"2026093005450950000_19.9.e274799.9","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0b013e3182142fd2"},{"key":"2026093005450950000_19.9.e274799.10","doi-asserted-by":"crossref","unstructured":"Wang Y , Xia J , Helfer B , et al . Valproate for schizophrenia. Cochrane Database Syst Rev 2016;2016. doi:10.1002\/14651858.CD004028.pub4","DOI":"10.1002\/14651858.CD004028.pub4"},{"key":"2026093005450950000_19.9.e274799.11","first-page":"28","article-title":"Sodium valproate induced necrotising pancreatitis: A case report","volume":"8","author":"Ali","year":"2013","journal-title":"Malays Fam Physician"},{"key":"2026093005450950000_19.9.e274799.12","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1177\/08971900261416787","article-title":"Presentation of Acute Pancreatitis After Initiation of Phentermine\/Topiramate for Weight Loss: An Adverse Drug Event Case Report","volume":"39","author":"Balli","year":"2026","journal-title":"J Pharm Pract"},{"key":"2026093005450950000_19.9.e274799.13","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1P350"},{"key":"2026093005450950000_19.9.e274799.14","article-title":"Lamotrigine-Induced Acute Pancreatitis","volume":"14","author":"Elmusa","year":"2022","journal-title":"Cureus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-274799","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:45:21Z","timestamp":1790772321000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-274799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":14,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,30]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-274799"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-274799","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}