Iatrogenic Hypoglycemia Induced by Valproic Acid in an Adult Patient

Literature on antiepileptic-induced iatrogenic hypoglycemia is scanty. Due to its broad spectrum of activity and mechanisms of action, valproic acid (VPA),a fatty acid, is one of the most widely prescribed epilepsy treatments worldwide. Herein, we describe an adult epileptic patient, in whom persistent, otherwise unexplained, hypoglycemia was most likely induced by VPA, as suggested by the VPA and glucose blood level time course. Indeed, no further hypoglycemic episodes occurred after VPA discontinuation and the diagnostic work-up ruled out other possible causes of hypoglycemia. This case supports the hypothesis that VPA may induce hypoglycemia, even in the absence of a VPA hepatotoxicity syndrome, due to still not well-defined metabolic mechanisms of action. Moreover, it emphasizes the fact that an iatrogenic pathogenesis should be considered V an apparently unexplained hypoglycemia occurs in a patient on chronic therapy with VIM, even at a therapeutical dosage.