Valproate overdose
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Hyperammonaemic encephalopathy in a neonate following accidental overdose: case report A 6-day-old male neonate with seizures developed hyperammonaemic encephalopathy after an accidental valproate overdose. The neonate had been receiving phenobarbital and phenytoin, but phenytoin was switched to oral valproate for persistent epileptiform activity. However, due to a dosage error, he received an accidental overdose of valproate 310 mg/kg, which was detected 4 hours after administration. The neonate received gastric lavage, saline, and a restricted-protein diet. Progressive hypoactivity, somnolence, and poor response to stimuli were noted. He underwent a blood exchange transfusion for progressively elevated ammonia levels, and was transferred to the ICU. On arrival, he was lethargic, with myotic but slowly reactive pupils, diminished muscle stretch reflexes, severe hypotonia, poor response to stimuli and poor spontaneous motor activity. Phenobarbital was withdrawn,and he received carnitine, sodium phenylbutyrate, benzoate, carglumic acid and a protein-free diet. Five days postoverdose, brain MRI showed a focal T1 prolonged signal in both his globi pallidi. His condition progressively improved, and he was discharged 13 days post-overdose, and started rehabilitation. One month later, his brain lesions had resolved. His physical examination and development were normal at his 1-year follow-up. Author comment: "Here, we report the case of a newborn that developed a hyperammonemic encephalopathy after a severe valproate overdose." Grynnerup A, et al. A severe valproate overdose with complete recovery in a newborn. Journal of Child Neurology 27: 1072-1076, No. 8, Aug 2012. Available 803077264 from: URL: http://dx.doi.org/10.1177/0883073811431497 - Spain
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Reactions 22 Sep 2012 No. 1420
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