PP07.6 – 2810: A rare cause of status epilepticus in infant; Alpha lipoic acid intoxication

Abstract

Objective Alpha lipoic acid (ALA), also known as thiotic acid, is a cofactor found in a number of multienzyme complexes. Lipoic acid is a powerful antioxidant and is widely used as supplementary treatment of diabetic neuropathy. There is no reported dose of safety in children. Methods A 14-month-old previously healthy girl was referred to our hospital with the diagnosis of drug intoxication. She was admitted to the emergency department with lethargy and involuntary movements for several hours after ingesting unknown number of pills of 600 mg ALA belonging to a diabetic parent at home. On admission she was lethargic, bilateral extensor toe sign, and having myoclonic seizures involving all extremities. She had no fever and laboratory examinations were normal except mild methabolic ascidosis (pH: 7.24). The seizures were unresponsive to bolus midazolam injection, fenitoin infusion at 20 mg/kg dose and levetiracetam infusion at 20 mg/kg dose. She was taken to the pediatric intensive care unit with the diagnosis of status epilepticus. Results After failure of the treatment with midazolam infusion (up to 1 mg/kg/hour) she was intubated and thiopental sodium infusion was started. Her myoclonic seizures was controlled with the thiopental sodium infusion (3 mg/kg/hour). After 48 hour intubation and mechanical ventilation the thiopental sodium infusion was gradually reduced and stopped. After withdrawing the thiopental sodium infusion she was seizure free, levetiracetam continued as anticonvulsant drug and she was discharged at the 8. day. Conclusion Alpha lipoic acid and derivatives cause side effects in children like refractory convulsions. As diabetes and the frequency of diabetic neuropathy increase, possibility of ALA usage and intoxication in children living in the same house also rises. When faced with refractory convulsions in children who have had no disease before, intoxication by medicaments with ALA should be taken into consideration.