Fulminant hepatic failure is an uncommon adverse effect of valproate treatment. Despite an increased use of valproate, since the drug was introduced in 1978, a decline in the number of reported cases has been observed. Here a case of hemorrhagic shock and fulminant hepatic failure in a patient treated with valproate is presented. We emphasize the diagnostic difficulties from the point of view of recognition of the clinical manifestations as well as the biochemical monitoring.