Midazolam
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Respiratory depression and lack of efficacy: case report A 15-month-old girl exhibited lack of efficacy and developed respiratory depression during treatment with midazolam for seizures. The girl, who had chronic renal failure on continuous cycling peritoneal dialysis (CCPD), was hospitalised due to clustered seizures. Her medical history was significant for respiratory failure due to bilateral polycystic kidneys, requiring bilateral nephrectomy at 12 weeks of age. She also had history of idiopathic left parieto-occipital lobe cerebral infarction at the age of 11 months. On the day of admission (current presentation), she suddenly vomited and exhibited convulsive seizures, which spread from the left upper extremity to the lower extremity at the end of the fifth cycle of the CCPD. She was treated with midazolam [route and dosage not stated]. However, her seizures were refractory to midazolam. Hyponatraemia was noted, and she started receiving 3% sodium chloride [saline], which controlled her seizures. Following midazolam therapy, her lactate level was 25 mg/dL, indicating hyperlactacidaemia. Eventually, she was intubated due to respiratory depression, which was attributed to midazolam [duration of treatment to reaction onset not stated]. Her hyponatremia slowly resolved. Concurrently she developed oedema of the right occipital lobe and post-stroke atrophy of the left parietal-occipital lobe. Further an inspection of the home CCPD equipment by her mother showed unopened septa of two out of the three PD fluid bags. On day 2 after admission, she was extubated, and her CCPD was resumed. Thereafter, she was discharged with no any new neurological sequelae. Aoki Y, et al. Hyponatremia due to unopened septa of peritoneal dialysis fluid bags. Pediatrics International 62: 878-879, No. 7, Jul 2020. Available from: URL: http:// 803500000 doi.org/10.1111/ped.14209
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Reactions 5 Sep 2020 No. 1820
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