We report a fatal case of haemorrhagic pancreatic necrosis in a 15-year-old mentally retarded epileptic male who had been taking sodium valproate (VPA) in the recommended dosage for one and a half years. The patient was admitted to hospital because of acute abdominal pain, with nausea and vomiting. Serum amylase was 609 U/l (normal range 100-360 U/l). Two exploratory laparotomies were performed. The second revealed haemorrhagic pancreatitis with areas of necrosis. VPA therapy was discontinued after the second laparotomy, but the patient died 25 days after admission. Autopsy showed extensive haemorrhagic pancreatic necrosis. Non-specific vomiting and abdominal pain occur frequently during VPA therapy, but VPA-related pancreatitis should be considered when there is severe abdominal pain with nausea and vomiting. Awareness of this problem and early discontinuation of VPA therapy may prevent serious reactions.