I asked our nurse to help with ordering labs: lamictal, trough depakote (1-2 hours before his dose of depakote ideally), CBC, CMP, and GGT (to make sure his liver function abnormalities are liver related). If these are fine, I will ask to increase his depakote further to 1 pill in am and 2 pills in pm or 375mg/day. If labs are not good, will have to discuss with you how to help with the myoclonus--these can be tricky to treat.
As for the carnitor, I agree with keeping him on it while on depakote. A multivitamin with good vitamin D source would also be good.
*****************
Bertrand was sent home from school today for "wheezing". His oxygen saturation is fine. And, of course, he has been happy and playful since he got home. The little faker. ;) Better safe than sorry, though!
*****************
UPDATE: So, Bertrand wasn't faking the cold. According to the blood work from this afternoon, he is definitely sick if cheerful. Because of that, I'm not putting much stock in his CBC numbers.
Disappointingly, Bertrand's liver enzymes were all elevated. ALT 82 (normal range: 5-45), AST 79 (normal range: 20-60) & GGT was 64 (normal range: 4-15). Granted, this is the lowest his GGT has ever been, but it breaks my heart to see his ALT & AST values creep up again.
Bertrand's trough depakote level was 57.7. Effective range is 50.0-125.0, so it is just barely in the effective range and definitely needs to be increased. This could lead to even more elevated liver values. Only time will tell, but all the more reason to keep monitoring him!
Hooray! Doesn't it seem wrong that we have to practically force a response sometimes? Hope B isn't getting sick. HUGS!
ReplyDelete