Lamotrigine/levetiracetam/lorazepam

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Various toxicities and lack of efficacy: case report A 2-year-old boy developed drowsiness, crying and seizures following accidental overdose of lamotrigine and lorazepam. Additionally, he exhibited lack of efficacy following treatment with levetiracetam for seizures. The boy ingested his sibling’s medications lorazepam 8mg and lamotrigine 600mg (43 mg/kg) during an unsupervised period. Thirty minutes later, his parents noted alternating periods of sleepiness and crying, leading to the discovery of the overdose. He was hospitalised. Upon arrival to the hospital, he was noted to be drowsy but arousable to touch. There was no vomiting, abnormal tone or movements. Two hours and 15 minutes post-ingestion of lamotrigine and lorazepam, he developed an episode of stiffness, jerking limbs, neck extension and deviated eyes. The episode lasted for < 10 seconds and was consistent with seizure. Two hours post-ingestion, his serum lamotrigine concentration was noted to be 33.7 mg/L, which was towards the higher end of the spectrum of measurements found in children with overdose. The ingested dose of 43 mg/kg of lamotrigine was mid-range for reported paediatric overdoses associated with seizures. The drowsiness, crying and seizure were considered to be secondary to lamotrigine and lorazepam overdose. The boy was treated with levetiracetam 20 mg/kg and was transferred to the ICU. Despite treatment with levetiracetam, he experienced three further generalised seizures one hour later (4 hours post-ingestion). Next morning, he was still drowsy, but was fit for discharge at 36 hours. McNulty R, et al. Seizures in a child with confirmed lamotrigine overdose despite levetiracetam loading. Clinical Toxicology 58: 549, No. 6, 2020. Available from: URL: 803502887 http://doi.org/10.1080/15563650.2020.1741981 [abstract]

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Reactions 26 Sep 2020 No. 1823

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