Chute significative des concentrations plasmatiques d’acide valproïque à la suite de l’introduction du méropénem
Bibliographic record
Abstract
Resume Objectif : Presenter un cas demontrant l’interaction entre l’acide valproique et le meropenem et discuter des mecanismes d’action qui la sous-tendent. Resume du cas : Il s’agit d’une patiente âgee de 51 ans se presentant pour un status epilepticus refractaire. L’administration de nombreux anticonvulsivants a du etre interrompue en raison d’effets indesirables importants (syndrome d’infusion au propofol et syndrome d’hypersensibilite aux anticonvulsivants). On a donc recouru a une forte dose d’acide valproique en association avec le levetiracetam. Au cours de l’hospitalisation, on a utilise le meropenem en raison de son meilleur profil d’innocuite neurologique. L’introduction de cet antibiotique a fait chuter les concentrations plasmatiques d’acide valproique de facon importante, sans consequences directes pour la patiente. Discussion : Dans la documentation scientifique, on rapporte plusieurs cas similaires a celui de cette patiente. Le mecanisme d’action qui explique cette interaction n’est pas completement elucide. Quelques hypotheses ont neanmoins ete soulevees. L’echelle de probabilite des interactions medicamenteuses indique une relation probable entre la chute soudaine des concentrations plasmatiques d’acide valproique et l’introduction du meropenem chez cette patiente. Conclusion : Les cliniciens doivent demeurer vigilants face a cette interaction cliniquement importante. Considerant le risque de chute soudaine des concentrations plasmatiques d’acide valproique, on devrait eviter autant que possible sa coadministration avec le meropenem. Abstract Objective: To present a case demonstrating the interaction between valproic acid and meropenem, and to discuss the underlying mechanisms of action. Summary of the case: Involved is a patient aged 51 presenting with refractory status epilepticus . Administration of numerous anticonvulsants had to be stopped due to significant adverse effects. (propofol related infusion syndrome and anticonvulsant hypersensitivity syndrome).We then tried a strong dose of valproic acid in association with levetiracetam. During hospitalization, we had used meropenem because of its better neurological safety profile. Introduction of this antibiotic caused a significant drop in plasma concentrations of valproic acid, without any direct consequences for the patient. Discussion: Several similar cases have been reported in the scientific literature. The mechanism of action underlying this interaction is not completely understood. Several hypotheses have nevertheless been suggested. The probability scale of drug interactions indicates a probable relation between the sudden drop in plasma concentrations of valproic acid and the introduction of meropenem in this patient. Conclusion: Clinicians must remain vigilant when confronted with this clinically significant interaction. Given the risk of a sudden drop in plasma concentrations of valproic acid, its co-administration with meropenem is to be avoided as much as possible. Key words: valproic acid; meropenem; interaction; plasma concentration; status epilepticus.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".