A case of Topiramate-induced metabolic acidosis

Abstract

Background & Significance : Topiramate (TPM) has been used as a mono-therapy or an adjunctive therapy for treating epilepsy. Metabolic acidosis caused by TPM could be related with an action of carbonic anhydrase inhibitor. Case : We experienced a 63-year-old woman with metabolic acidosis caused by topiramate, which subsided after withdrawal of topiramate. She was diagnosed epilepsy & diabetes mellitus 2 years ago. She treated by tegretol at first, and changed by topiramate 2 months ago due to drug toxicity. She visited our hospital by hypoglycemia at first. At visiting, she revealed hyperventilation & metabolic acidosis laboratory findings. After admission, metabolic acidosis was continued. We reviewed all other factor and checed her medication, and concluded that metabolic acidosis may be induced by topiramate. After cessation of medication, metabolic acidosis is improved. Conclusions or Commentes : A patient with metabolic acidosis caused by TPM has not been reported yet in Korea. We report metabolic acidosis by topiramate. Monitoring bicarbonate levels before and during TPM therapy may be indicated, especially with conditions that predispose to acidosis.