Abstract | BACKGROUND: CASE PRESENTATION: A 9-year-old girl was treated with high-dose, continuous intravenous infusion of midazolam for the management of refractory status epilepticus. The patient developed a severe hyperchloremic, non-anion gap metabolic acidosis and resultant hemodynamic compromise, necessitating significant inotropic support and the initiation of a vasopressor infusion. We speculate that this complication was due to the preparation of parenteral midazolam with hydrochloric acid. The midazolam infusion was stopped, and, in less than 5 hours, the patient's metabolic acidosis resolved. The patient's inotropic and vasopressor infusions could only be weaned after discontinuing the use of high-dose midazolam. CONCLUSIONS: Although this complication was observed in only 1 pediatric patient with cortical dysplasia, caution and close clinical and laboratory surveillance should be exercised when administering continuous intravenous infusions of midazolam to pediatric patients.
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Authors | Myke D Federman, Robert Kelly, Rick E Harrison |
Journal | Clinical neuropharmacology
(Clin Neuropharmacol)
2009 Nov-Dec
Vol. 32
Issue 6
Pg. 340-1
ISSN: 1537-162X [Electronic] United States |
PMID | 19952873
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Anticonvulsants
- Cardiotonic Agents
- Vasopressins
- Midazolam
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Topics |
- Acidosis
(chemically induced, complications)
- Anticonvulsants
(administration & dosage, adverse effects)
- Cardiotonic Agents
(therapeutic use)
- Child
- Dose-Response Relationship, Drug
- Electroencephalography
- Female
- Humans
- Infusions, Intravenous
- Midazolam
(administration & dosage, adverse effects)
- Status Epilepticus
(complications, drug therapy)
- Vasopressins
(therapeutic use)
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