Management of Keppra (Levetiracetam)-Induced Diarrhea in a 6-Year-Old Girl
The most effective approach for managing Keppra-induced diarrhea in a 6-year-old girl is to focus on oral rehydration therapy while continuing the medication, unless symptoms are severe enough to warrant medication adjustment.
Assessment and Initial Management
- Evaluate the child for signs of dehydration, including skin turgor, mucous membranes, mental status, and urine output 1
- Assess the severity of diarrhea and its impact on the child's quality of life and seizure control 2
- Rule out other causes of diarrhea such as infections before attributing it solely to Keppra 1
Hydration Management
- For mild to moderate dehydration (3-9% fluid deficit), administer oral rehydration solution (ORS) at 50-100 mL/kg over 2-4 hours 1
- For maintenance and ongoing losses, replace each watery stool with approximately 10 mL/kg of ORS 1
- Use small, frequent volumes (e.g., 5 mL every minute) if vomiting is also present 1
- For severe dehydration (≥10% fluid deficit), immediate IV rehydration may be necessary 1
Dietary Considerations
- Continue the child's regular diet during the diarrheal episode 1
- Focus on foods that are less likely to worsen diarrhea: starches, cereals, yogurt, fruits, and vegetables 1
- Avoid foods high in simple sugars and fats, which can exacerbate diarrhea 1
- If lactose intolerance is suspected (worsening of diarrhea with dairy consumption), temporarily reduce or remove lactose from the diet 1
Medication Management
- Antidiarrheal medications are generally not recommended for drug-induced diarrhea in children 1, 3
- Racecadotril may be considered in severe cases as it has shown efficacy in reducing stool output in children with acute diarrhea 3, 4
- Loperamide is contraindicated in children under 2 years and not recommended in this case 3
- Probiotics may provide some benefit in reducing the duration of diarrhea, though evidence for drug-induced diarrhea specifically is limited 3, 4
Keppra Dosing Considerations
- If diarrhea is severe or persistent, consult with the child's neurologist about potential dose adjustment 2, 5
- Children typically require higher weight-normalized doses of levetiracetam compared to adults due to faster clearance 5
- Any changes to Keppra dosing must balance seizure control against gastrointestinal side effects 2
Monitoring and Follow-up
- Monitor hydration status frequently during treatment 1
- Instruct parents to seek immediate medical attention if the child becomes irritable, lethargic, has decreased urine output, develops intractable vomiting, or has persistent diarrhea 1
- Consider alternative antiepileptic medications only if diarrhea is severe, persistent, and significantly affecting quality of life despite appropriate management 2
Important Caveats
- Behavioral side effects can also occur with levetiracetam in children; monitor for any changes in behavior or mood alongside gastrointestinal symptoms 2
- Avoid abrupt discontinuation of Keppra as this may precipitate seizures; any medication changes should be gradual and supervised by a neurologist 2
- Drug-induced diarrhea may improve with continued use as tolerance develops, so supportive management may be sufficient in many cases 6