title: A rare cause of status epilepticus; alpha lipoic acid intoxication, case report and review of the literature.
abstract: BACKGROUND
  Alpha lipoic acid is a powerful antioxidant widely used for the supplementary treatment of diabetic neuropathy. Intoxication with alpha lipoic acid is very rare. 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 continuing involuntary movements for several hours after she had ingested an unknown amount of alpha lipoic acid. On admission she was lethargic and had myoclonic seizures involving all extremities. She had no fever and laboratory examinations were normal except for mild metabolic acidosis. The seizures were unresponsive to bolus midazolam, phenytoin infusion and levetiracetam infusion. She was taken to the pediatric intensive care unit with the diagnosis of status epilepticus. After failure of the treatment with midazolam infusion she was intubated and thiopental sodium infusion was started. Her myoclonic seizures were controlled with thiopental sodium infusion. After 48 h intubation and mechanical ventilation thiopental sodium was gradually reduced and then stopped. Following the withdraw of thiopental sodium, she was seizure free on her discharge on the 8th day.
  
  
  CONCLUSIONS
  Alpha lipoic acid and derivatives cause side effects in children like refractory convulsions. They are frequently rendered as vitamins by diabetic patients and are left at places where children can easily access them. Therefore, when faced with refractory convulsions in children who have had no disease before, intoxication by medicaments with alpha lipoic acid should be taken into consideration.
authors.affiliation: Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey. Electronic address: orkuntolunay@yahoo.co.uk.
authors.forename: Orkun
authors.initials: O
authors.lastname: Tolunay
authors.affiliation: Department of Pediatric Neurology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Çelik
authors.affiliation: Department of Pediatric Neurology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kömür
authors.affiliation: Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Ali Emre
authors.initials: AE
authors.lastname: Gezgin
authors.affiliation: Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Musa Soner
authors.initials: MS
authors.lastname: Kaya
authors.affiliation: Department of Pediatric infection, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Çelik
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D004831:Epilepsies, Myoclonic / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D000077287:Levetiracetam; D008874:Midazolam / Q000627:therapeutic use; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D012121:Respiration, Artificial; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D013226:Status Epilepticus / Q000139:chemically induced*; D008063:Thioctic Acid / Q000506:poisoning*; D013874:Thiopental / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D008063:Thioctic Acid; D013874:Thiopental; D008874:Midazolam; D010889:Piracetam
keywords: Alpha lipoic acid; Infant; Intoxication; Status epilepticus