Female patient, one year old and 10 kg body weight, with a history of spastic tetraparesis and epilepsy in monotherapy with oral phenobarbital.
The patient was admitted to the ICU due to an intraventricular hemorrhage and an external ventricular shunt was performed.
flu virus A H1N1 encephalopathy, which required phenobarbital 7 mg/kg/day, phenytoin 5 mg/kg/day and lorazepam, all administered intravenously
Three days after its onset, she continued to have seizures, so levetiracetam was added and the first plasma level of valproic acid was taken, 23.9 mcg/ml, so the dose was increased to 50 mcg/kg.
The next day the patient was diagnosed with a ventriculo-slicosis due to cloacah sensitive only to meropenem, so it was started at a dose of 120 mg/kg/day, achieving CSF sterilization.
Successive plasma valproic acid levels on days 5 and 6 of septic therapy showed values lower than 0.19 μg/ml, remaining at 3 μg/ml per day 18.
He completed 21 days of meropenem with good response and without developing new seizures.
Recovery of plasma valproic acid levels after completion of 95.6 to 45kg doses was slow with values of 3.4 μg/ml at 10 days; 11.8 μg/ml at 28 days;
There were no changes in liver enzymes or albumin during hospitalization.
Sixty-six days after the end of the combined therapy, the patient was discharged with fenobarbital, levetiracetam and oral valproic acid.
