Upper abdominal pain in a patient taking Depakote may indicate which emergency?

• A. Pancreatitis
• B. Gastritis
• C. Appendicitis
• D. Cholecystitis

Answer: (A)

Valproate can cause drug-induced pancreatitis, a serious emergency. When pancreatitis occurs, patients often have sudden, severe upper abdominal pain that may radiate to the back, often with nausea and vomiting. Because this can be life-threatening, it requires immediate evaluation and action. If suspected, discontinue valproate and obtain pancreatic enzyme levels (lipase or amylase) along with liver tests and basic metabolic studies, then proceed with prompt management: IV fluids, pain control, and NPO as indicated, with imaging (ultrasound or CT) as needed to assess inflammation. While gastritis, appendicitis, or cholecystitis can cause abdominal pain, their link to Depakote is not as direct, and they don’t carry the same urgent risk profile in the context of valproate exposure.