Inquest into the death of Janis Ellen Doherty

57y · Female·Multi-organ failure due to drug-induced liver injury caused by sodium valproate hepatotoxicity

Mrs Doherty, a 57-year-old woman with CADASIL syndrome, was prescribed sodium valproate for migraine prophylaxis in November 2019. She developed acute hepatitis approximately 5 months later, presenting with jaundice, nausea, and dark urine. Critical failures in clinical management included: (1) failure to cease sodium valproate immediately upon admission to Caboolture Hospital despite recognition that it was a potential hepatotoxin and prescribed for non-essential migraine relief; (2) continuation of aspirin throughout her admission at Caboolture Hospital despite plans for liver biopsy, delaying the procedure; (3) inappropriate re-introduction of sodium valproate at Royal Brisbane and Women's Hospital on 29 April 2020 before DILI had been excluded on biopsy; and (4) failure to contact the prescribing neurologist for clarification about the drug's indication. Early cessation of sodium valproate at admission, cessation of aspirin when biopsy was contemplated, and avoidance of re-introduction might have offered her a reasonable chance of recovery, as at that point she had acute hepatitis without synthetic liver dysfunction.