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Metabolic acidosis developed in eight children after 8–26 days (median 14 days) of topiramate treatment with a minimum serum HCO 3 between 15 and 18 mM (median 17 mM), and pH between 7.22 and 7.40 (median 7.35). Four of nine children showed clinical signs of hyperventilation and received oral sodium HCO 3.
Any signs of metabolic acidosis or topiramate-related side effects were investigated. Blood chemistry levels and arterial blood gases, including lactate, were obtained. The severity of metabolic acidosis was defined according to base excess levels as mild or moderate.
Metabolic acidosis is a condition in which acids build up in your body. Causes include untreated diabetes, the loss of bicarbonate in your body and kidney conditions. Symptoms include an accelerated heartbeat, confusion and fatigue. Blood and urine tests can help diagnose it.
Arterial blood gas analysis in a topiramate overdose usually shows hyperchloremic normal anion gap metabolic acidosis. In 7 cases of topiramate toxicity observed by Poison Control Centers in Poland, somnolence was the most common symptom (66.7%), along with agitation, mydriasis, and vertigo (33.4%).
Severe metabolic acidosis is common among critically ill patients, and topiramate is a rare cause that may fail recognition. We report a lady with acute encephalopathy who had severe non-anion gap metabolic acidosis that served as the clue leading to suspicion and diagnosis of topiramate
Its inhibition of carbonic anhydrase isoenzymes can lead to metabolic acidosis, elevated urine pH, reduced urine citrate, and hypercalciuria, thereby creating a milieu that is ripe for calcium phosphate stone formation. In this review, we describe a case of topiramate-induced metabolic acidosis.
Its inhibition of carbonic anhydrase isoenzymes can lead to metabolic acidosis, elevated urine pH, reduced urine citrate, and hypercalciuria, thereby creating a milieu that is ripe for calcium phosphate stone formation. In this review, we describe a case of topiramate-induced metabolic acidosis.
(1) Topiramate carries a dose-dependent risk of severe metabolic acidosis in adults and children. (2) Various situations increase the risk, including diarrhea, respiratory disorders and surgery. (3) Loss of appetite, fatigue and hyperventilation are warning signs.
Baseline and periodic serum bicarbonate concentration measurements are recommended during topiramate therapy. Patients prescribed topiramate should be educated about the symptoms of metabolic acidosis and urged to report their occurrence promptly to a healthcare provider.
Topiramate is a new anticonvulsant drug recommended for treatment of partial and generalized seizures in children and adults. It has been found to cause a nonanion gap metabolic acidosis in some patients, which is related to carbonic anhydrase inhibition.