title: Simultaneous toxicities in a child on multiple anticonvulsants.
abstract: It is rare to develop simultaneous toxicities while on anticonvulsants. This article presents a 3(1/2)-year-old child on valproic acid, lamotrigine, and phenytoin who developed simultaneous hepatotoxicity and bone marrow toxicity during a parainfluenza virus type 3 infection. These toxicities resolved after the cessation of anticonvulsants, and her seizures were managed acutely with scheduled lorazepam. This article discusses the possibility that simultaneous use of valproic acid, lamotrigine, and phenytoin could give this combination of toxicities and that concurrent viral infection may increase this risk.
authors.affiliation: Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Sarah Isis R
authors.initials: SI
authors.lastname: Delima
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Walsh
authors.forename: Meredith R
authors.initials: MR
authors.lastname: Golomb
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D001853:Bone Marrow / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D001855:Bone Marrow Diseases / Q000139:chemically induced* / Q000821:virology; D056486:Chemical and Drug Induced Liver Injury; D002675:Child, Preschool; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008099:Liver / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D008107:Liver Diseases / Q000821:virology; D008140:Lorazepam / Q000009:adverse effects; D010224:Parainfluenza Virus 3, Human; D018184:Paramyxoviridae Infections / Q000150:complications*; D010672:Phenytoin / Q000009:adverse effects; D013226:Status Epilepticus / Q000188:drug therapy / Q000503:physiopathology; D014227:Triazines / Q000009:adverse effects; D014635:Valproic Acid / Q000009:adverse effects
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D014635:Valproic Acid; D010672:Phenytoin; D008140:Lorazepam; D000077213:Lamotrigine