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Monday, July 30, 2007

help desk - medical

This is way, way off-topic, but I'm posting in case anyone has experience in this area.

We've had a medication snafu with Jimmy.

I was trying to boil the med snafu down to one sentence, but now that I've surfed some web sites I see that boiling it down isn't working.

As briefly as I can put it:

  • Depakote is an anticonvulsant Jimmy takes to control a very mild seizure disorder.
  • To work, Depakote has to be maintained at a certain level in the blood.
  • Jimmy takes one dose of Depakote a day, always at bedtime.

The snafu:

  • Last night Ed discovered he had probably given Jimmy his nighttime dose of Depakote that morning by mistake (we were out of town, pill box was turned upside down in suitcase, etc.)
  • At that point we decided to skip his bedtime meds because he'd already taken them that morning.

So here's the question.

What should we have done?

And what should we do now?

I just picked Jimmy up from school, where he fell asleep during speech therapy and couldn't be aroused. Then, in the nurse's office, he woke up, "fell asleep," woke up again, fell asleep again, etc. His behavior was pretty close to what you'd call passing out, not falling asleep.

He's acting fine now.

The nurse says her intuition is that, in the case of Depakote, it's probably better to overshoot than to undershoot, but she doesn't know.

Does anyone have experience with this?

We've emailed his doctor, so we'll have professional advice shortly. But if anyone has experience or knowledge I'd like to get it.

Thanks!

18 comments:

  1. call your local pharmacist

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  2. Based on a family member's experience with Depakote, I don't think you want to risk overshooting. (My family member temporarily lost the ability to swallow and had to be tube fed for a while. This may have been partly due to an interaction between Depakote and another drug.)

    You also need to read up on how they measure blood level. Apparently these measurements can be off depending on time-of-day, food consumed, and so forth. (Incorrect measurement is our best guess of what went wrong in our situation.)

    You need to get this right.

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  3. call your local pharmacist

    OH!

    I didn't even think of that.

    Good idea.

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  4. Based on a family member's experience with Depakote, I don't think you want to risk overshooting.

    THANK YOU!

    That was Ed's instinct - he just didn't think Jimmy should end up with extra Depakote in his system.

    wow

    Thanks so much for posting.

    I'm going to call our pharmacist, too. He's great - he'll have thoughts.

    Haven't heard back from our doctor yet, but Jimmy's fine so I'm expecting him to get through the day OK until tonight.

    Even if he doesn't, he'll be here at home sitting on the sofa, so he'll have a "soft landing."

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  5. Susan - you were right!

    Ed just heard back from Eric (Hollander).

    He says just wait 'til tonight and give him his normal dose.

    Of course the scary thing is that he was overdosed yesterday all day long and we didn't know it. (Hard to explain - we didn't take the whole pill box, just pulled one "Day" out of the thing. Ed thinks he pulled it out of his bag upside down and didn't notice which way was up....)

    That's confusing.

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  6. My spouse says that most meds have a built in safety net so that you can accidentally mess up a single dose without much problem.

    Not true for all meds, of course. How's Jimmy doing tonight? Did you decide to give him his meds as usual?

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  7. Hi Lynn!

    My spouse says that most meds have a built in safety net so that you can accidentally mess up a single dose without much problem.

    This is what we've always seen....so we weren't taking anything too seriously until suddenly Jimmy was so funky at school.

    He was fine as soon as he got home, and was normal for the rest of the day, so...who knows?

    Autism is so funky; you just never know.

    thanks for checking with your husband!

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  8. It was kind of funny, I was about 1/2 way through reading your post to him and when I said Jimmy had gotten too much depakote he said, well, that should make him sleepy, I think.

    And I'm saying, yeah! he is sleepy!

    So, I guess that's good.

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  9. Parents do lots of really horrible things by accident.

    The NYT had an article over the weekend on calls to the Poison Control Center. That might have been in just the CT section.

    Anyway, lots worse things happen all the time. Too much depakote is probably pretty mild in the world of accidental medication snafus.

    Forgetting to give your kid anti-rejection meds after a heart transplant is much worse.

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  10. Just got in (whew it's late) but I was thinking about Jimmy and had to check in before I could get some sleep. I'm glad all is well. Sure you are too. Good night... good morning?

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  11. Forgetting to give your kid anti-rejection meds after a heart transplant is much worse.

    good lord

    Actually, he had too little Depakote, which is why I was worried. His behavior seemed seizure-like...

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  12. (He had too little Depakote because, having given him his nighttime dose in the a.m. Ed decided not to give him another dose that night, when he should have had it.)

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  13. oh gosh, I'm sorry!

    I didn't mean to worry you!

    We don't get worried, because we've worked with meds for so long that we have an "intuitive" understanding of what Lynn just told me: most meds have a built-in safety net.

    There is no way on Earth you can be handling meds for 15 years without making mistakes - and we've made plenty.

    I'm glad to have this idea formalized, though.

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  14. I once took the dog's medicine by accident.

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  15. I probably shouldn't have said that.

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  16. In any case, mom-taking-the-dog's-medicine became a source of merriment for a couple of days there.

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