Severe Non-Anion Gap Metabolic Acidosis Induced by Topiramate: A Case Report

Shiber, Joseph

doi:10.1016/j.jemermed.2008.11.017

Cited by 19 publications

(11 citation statements)

References 13 publications

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“…Hyperchloremic, nonanion gap, metabolic acidosis is associated with topiramate treatment. This metabolic acidosis is caused by renal bicarbonate loss due to the inhibitory effect of topiramate on carbonic anhydrase [Shiber, 2010].…”

Section: Psychopharmacotherapy In Adultsmentioning

confidence: 99%

Pharmacotherapy of disruptive behavior in mentally retarded subjects: A review of the current literature

Häßler

Reis

2010

Dev Disabil Res Revs

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The review presented here describes the state of the art of pharmacological treatment of aggression in subjects with mental retardation (MR) summing up results for both, children and adults. In general, psychopharmacological treatment of disruptive behavior in individuals with MR is similar to the treatment in subjects without MR. Compared to individuals without MR medication should "start lower and go slower." For children and adults results were similar but were obtained by somewhat different medications. There is evidence for the conventional antipsychotic zuclopenthixol having positive effects on disruptive behavior. Most studies described the atypical antipsychotic risperidone to control severe self-injurious behavior and other behavior problems in a variety of diagnoses. Anticonvulsants, antidepressants, and anxiolytic medications are reported as effective as well for the treatment of individuals with disruptive behavior. Aggression-related behavior often gets treated with stimulants or with stimulants combined with atypical neuroleptics.

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Section: Psychopharmacotherapy In Adultsmentioning

confidence: 99%

Pharmacotherapy of disruptive behavior in mentally retarded subjects: A review of the current literature

Häßler

Reis

2010

Dev Disabil Res Revs

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“…publications found with both search terms). A total of 72 of them were reviewed in detail, and 47 articles published between 1996 and 2013 were retained for the final analysis, following inclusion of reports found in references (41 in English , five in Spanish and one in German ). They had been reported from following countries: USA ( n = 17), Spain ( n = 5), Great Britain ( n = 4), France ( n = 3), Italy ( n = 3), Brazil ( n = 2), Switzerland ( n = 2), Turkey ( n = 2), Argentina ( n = 1), Australia ( n = 1), Belgium ( n = 1), China ( n = 1), Germany ( n = 1), Hong Kong ( n = 1), Mexico ( n = 1), The Netherlands ( n = 1) and Saudi Arabia ( n = 1).…”

Section: Resultsmentioning

confidence: 99%

“…Symptoms likely to be related to metabolic acidosis were noted in two (1.3%) of the patients included in case–control studies and in 28 (22%) of those included in longitudinal studies. Symptoms of acidosis were also reported in 10 patients included in anecdotal reports containing two or fewer cases . The reported symptoms included deep and laboured breathing with increased frequency (in one case associated with chest pain), nausea with or without vomiting and central nervous system disturbances, such as lethargy or irritability and hallucinations.…”

Section: Resultsmentioning

confidence: 99%

Metabolic disturbances and renal stone promotion on treatment with topiramate: a systematic review

Dell’Orto

Belotti

Goeggel-Simonetti

et al. 2014

Br J Clin Pharmacol

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AIMSThe use of topiramate, which is prescribed for the management of epilepsy, for migraine headache prophylaxis and as a weight-loss agent, has been associated with the development of metabolic acidosis, hypokalaemia and renal stone disease. We systematically reviewed all the literature. METHODSThe systematic review of the literature was realized using the principles underlying the UK Economic and Social Research Council guidance on the conduct of narrative synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTSFourty-seven reports published between 1996 and 2013 were retained for the final analysis. Five case-control studies and six longitudinal studies addressed the effect of topiramate on acid-base and potassium balance. A significant tendency towards mild-to-moderate hyperchloraemic metabolic acidosis (with bicarbonate ≤21.0 mmol l −1 in approximately every third case) and mild hypokalaemia (with potassium ≤3.5 mmol l −1 in 10% of the cases) was noted on treatment with topiramate, which was similar in children and adults. A single study observed that topiramate causes mild hyperuricaemia in male adults. A tendency towards hypocitraturia, a recognized promoter of renal stone formation, was noted in all patients on topiramate. CONCLUSIONSIncreasing evidence supports the use of topiramate. Topiramate is generally well tolerated, and serious adverse events are rare. Nonetheless, the present systematic review of the literature indicates that its use is linked with the development of acidosis, hypokalaemia, hyperuricaemia and hypocitraturia.

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“…Several reports describe toxicity at varying doses of ingestion when used for migraine and epilepsy (Table 2) [4,5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Based on a retrospective review of 567 cases of topiramate toxicity (during 2000-2001), the American Association of Poison Control revealed that: 39% were adults, mild mental status changes were common, and severe respiratory depression or persistent NAGMA were infrequent yet other reports confirm their occurrence [5,[10][11][12]. NAGMA was of high diagnostic value in our patient's case as history was negative for any other causes of NAGMA enumerated in Our patient probably ingested an unknown number of topiramate 100 mg immediate release tablets.…”

Section: Discussionmentioning

confidence: 99%

Topiramate, a concealed cause of severe metabolic acidosis

Lovinger¹,

Schroeder²,

Ludwig³

et al. 2017

Am J Hosp Med

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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 toxicity and was confirmed by elevated blood topiramate levels. Additionally, we provide a review of literature on all reported cases of topiramate toxicity.

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Severe Non-Anion Gap Metabolic Acidosis Induced by Topiramate: A Case Report

Cited by 19 publications

References 13 publications

Pharmacotherapy of disruptive behavior in mentally retarded subjects: A review of the current literature

Pharmacotherapy of disruptive behavior in mentally retarded subjects: A review of the current literature

Metabolic disturbances and renal stone promotion on treatment with topiramate: a systematic review

Topiramate, a concealed cause of severe metabolic acidosis

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