Valproate Hepatotoxicity — RACP Paediatrics MCQ

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HardNeurology & DevelopmentValproate HepatotoxicityRACP Paediatrics

A 2-year-old child with epilepsy on sodium valproate presents with vomiting, lethargy, and hepatomegaly. Liver function tests are severely deranged. What is the most important consideration?

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Correct answer: D — Valproate-induced hepatotoxicity

Valproate hepatotoxicity is most common in children under 2 years, especially those with mitochondrial disorders or on polytherapy. It can present as fulminant hepatic failure. Valproate should be stopped immediately. L-carnitine supplementation and supportive care are essential. Valproate should be avoided in suspected mitochondrial disease.

Reference: AMH Children's Dosing Companion – 2024 – Sodium Valproate