Female patient, 5 years old and 23 kg of body weight, with a history of cerebral palsy due to neonatal asphyxia and epilepsy, in prolonged treatment with oral valproic acid, 32 mg/kg/day administered by nasogastric tube.
The patient was admitted to the ICU due to adenovirus pneumonia associated with severe respiratory failure and refractory hypovoloclin-hypovolemia, antimicrobial agents, receiving cefazolin IV in doses of stress and septic shock.
On the eighth day of hospitalization a plasma level of valproic acid was taken, which resulted in 90.1 μg/ml.
The tenth day of hospitalization presented a hemodynamic and respiratory deterioration, with tracheal aspirate culture for Pseudomonas aeruginosa, so antimicrobial scheme was changed to vancomycin and meropenem (120 mg/kg/day), maintaining amikacin
After five days of treatment with meropenem, valproic acid was monitored, with a plasma value < 3 μg/ ml.
Per rescaling strategy was suspended from the Sociedad Colombiana de Anestesiología y Reanimación.
Valproic acid was increased to 45 mg/kg/day, controlling a new plasma level seven days after meropenem discontinuation, which resulted in 55 μg/ml.
Fourteen days after discontinuation of meropenem, the patient developed new deterioration due to sepsis caused by cloacae sepsis and hemocultives. The same tracheal secretion was re-initiated and reinitiated on a new dose of 3 μg.
It was maintained with the same dose of valproate.
Twenty days later, the patient died due to refractory hypoxemic failure.
