Refractory metabolic acidosis as a complication of high-dose midazolam infusion for pediatric status epilepticus.
BACKGROUND
The use of midazolam for the treatment of status epilepticus in children has generally been shown to be well tolerated and safe. Furthermore, encouraging efficacy has been observed when pediatric patients with status epilepticus have received continuous intravenous infusions of midazolam.


METHODS
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.
Federman
Myke D
MD
Division of Pediatric Critical Care, Department of Pediatrics, Mattel Children's Hospital UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095, USA. mfederman@mednet.ucla.edu
Kelly
Robert
R
Harrison
Rick E
RE
D000138:Acidosis / Q000139:chemically induced* / Q000150:complications; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D013226:Status Epilepticus / Q000150:complications / Q000188:drug therapy*; D014667:Vasopressins / Q000627:therapeutic use
D000927:Anticonvulsants; D002316:Cardiotonic Agents; D014667:Vasopressins; D008874:Midazolam