Brief Answer:
Just her next dose on schedule and VERIFY the # of ml to give.

Detailed Answer:
So long as you do not make those sorts of errors on a regular basis nothing dramatic will happen.

Your daughter take her next dose on time at the correct dose. Nothing adverse should happen with 1 aberrant dose. You didn't specify the weight of your daughter or the # of mg./kg/day that her pediatric neurologist is calculating but given her age my guess is that she is being dosed at approximately 20mg./kg/day in 2 divided doses. This is standard dosing practice for someone her age. I am also going to hazard a guess and say that your daughter weighs approximately 20kgs. or 44 lbs.

This means that TYPICALLY she will receive 400mg. of medication per day. However, because she accidentally got a little extra tonight and assuming she got the CORRECT amount this morning of 200mg. (4 cc. of 250mg./5 cc) then, she received a total dose today of 700mg. instead of 400mg. So in fact, she would've received 35mg./kg/day with that additional dose for only 1 day which is still within the range of acceptable mg dosing for individuals up to age 6 which is 15-40mg/kg/day.

This is unlikely to significantly her serum concentration so long as you return to the normal dosing schedule. In order to alter her serum concentrations to any great extent she would have to be on an increased (or decreased) amount of the medications TWICE DAILY EVERY DAY for at least 4-7 days before seeing any concentrational changes in her bloodstream. So you can see that one elevated dose will not make any overall difference to her blood levels. So, there is no cause for alarm.

You do NOT want to skip any doses just because she got this extra amount. You do not need to make emergency trips to the ER or any such things. Business as normal. She could possibly a little more sleepy or fatigued in the morning when she awakens or she may not feel anything odd at all since she'll have the night to "sleep it off."

The only thing I might really recommend is that you figure out why she received this extra dose and devise a plan so it doesn't happen again. If there was confusion of how much medication to actually pull into a syringe or pour into a spoon or put in a dosing cup then, you should address how such quantities can be better guaranteed to be administered. You may also wish to come up with a VERIFICATION PLAN so that once the dosage is pulled...there be a 2nd step to actually verify that it is the 4 cc. you've drawn out for her to ingest.

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