Valproate-induced fatal hepatotoxicity is rare overall. Which patient group carries the greatest risk?
- A Children under 2 years receiving multiple antiepileptic drugs ✓
- B Adults over 40 years on monotherapy
- C Adolescents on monotherapy for migraine prophylaxis
- D Pregnant women in the third trimester
Correct answer: A. Children under 2 years receiving multiple antiepileptic drugs
Explanation
Age under 2 years and polytherapy are the two strongest independent risk factors for idiosyncratic valproate hepatotoxicity, and many affected infants have underlying mitochondrial enzyme defects impairing beta-oxidation. Risk falls steeply after age 10 and with monotherapy, so adults on monotherapy are at minimal risk, which eliminates options B and C.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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