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Refractory metabolic acidosis as a complication of high-dose midazolam infusion for pediatric status epilepticus

Myke D Federman1, Robert Kelly, Rick E Harrison

  • 1Division 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

Clinical Neuropharmacology
|December 3, 2009
PubMed

Insights

Continuous intravenous midazolam infusion for pediatric status epilepticus can cause severe metabolic acidosis. Healthcare providers should carefully monitor children receiving high-dose midazolam infusions.

Area of Science:

  • Pediatric critical care medicine
  • Neuropharmacology

Background:

  • Midazolam is generally safe and effective for pediatric status epilepticus.
  • Continuous intravenous infusions of midazolam show encouraging efficacy in pediatric patients.

Observation:

  • A 9-year-old girl with refractory status epilepticus received high-dose, continuous intravenous midazolam.
  • The patient developed severe hyperchloremic metabolic acidosis and hemodynamic compromise.

Findings:

  • The complication is suspected to be due to hydrochloric acid in the midazolam preparation.
  • Metabolic acidosis resolved within 5 hours of stopping the midazolam infusion.
  • Inotropic and vasopressor support was weaned after midazolam discontinuation.

Implications:

  • Caution is advised when administering continuous intravenous midazolam infusions to pediatric patients.
  • Close clinical and laboratory monitoring is essential for pediatric patients receiving high-dose midazolam.
  • This complication highlights potential risks associated with parenteral midazolam preparation.
Abstract

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