Sodium valproate-induced enuresis in a pediatric bipolar patient
“Z,” a 14-year-old girl, was referred to our child psychiatry clinic because she was experiencing a mania episode. Both a magnetic resonance imaging scan and an electroencephalography revealed no hint of an organic cause of her manic symptoms. Since her history also revealed a depressive episode, she was diagnosed as having bipolar disorder type 1 using the Kiddie-Sads-Present and Lifetime Version. Then, the Young Mania Rating Scale was used to measure the severity of her manic symptoms; her score was 45.\nWe started treatment with SV 250 mg/day for the first 4 days. We also administered risperidone 1 mg/day to resolve the ideas of reference symptom throughout the course of treatment. At the 15th day, the dose of SV was titrated to 750 mg/day (250 mg at noon and 500 mg at night). Since the SV dose reached 750mg/day Z began bedwetting. About 4 weeks later, when the dose of SV was titrated up to 500mg twice a day (a blood level of 75μg/ml), Z developed diurnal and nocturnal enuresis every day at the fifth week, she even had urinary incontinence in the classroom at school.\nZ had not taken SV before, and her personal history revealed that she achieved urinary bladder control at 4 years old; since then, she had had no urinary incontinence. The family history was negative for enuresis, and urological and neurological evaluations were normal. Because of the enuresis, the SV dose was reduced to 500 mg/day (a blood level of 38.3 μg/mL), and her bedwetting disappeared completely 2 days later. At her follow-up visit half a year later, she appeared to be well adjusted to the treatment, which consisted of SV at 500 mg/night and risperidone 1 mg/day.