Which of the following should be monitored for pancreatitis in patients taking valproic acid?

• A. Liver function tests
• B. Signs and symptoms of pancreatitis
• C. Pulmonary function tests
• D. Thyroid function tests

Answer: (B)

Pancreatitis is a potential adverse effect of valproic acid, so the focus for monitoring is recognizing clinical signs of pancreatitis. Early detection relies on asking about and evaluating for abdominal pain, nausea, vomiting, and abdominal tenderness, which may prompt checking pancreatic enzymes (lipase/amylase) and imaging if suspected. While liver function tests are important for monitoring valproic acid–related hepatotoxicity, they do not identify pancreatitis. Pulmonary and thyroid function tests have no direct relevance to pancreatitis monitoring. Therefore, watching for the patient’s signs and symptoms of pancreatitis is the most appropriate monitoring approach.