Acute Mental Status Changes and Hyperchloremic Metabolic...
Mental status changes and metabolic acidosis may occur with topiramate therapy. These adverse events were reported during dosage titration and with high dosages of the drug. A 20-year-old man receiving topiramate, valproic acid, and phenytoin experienced acute-onset mental status changes with hyperchloremic metabolic acidosis. He had been receiving a modest dose of topiramate for 9 months. He was weaned off topiramate over 5 days, and his mental status returned to baseline within 48 hours of discontinuing the agent. This case illustrates the need for close evaluation of patients who experience acute-onset mental status changes during topiramate therapy.
Alteration of mental status is the most common adverse effect associated with anticonvulsant therapy. Topiramate (TPM) is a relatively new anticonvulsant given for adjunctive treatment of refractory partial seizure disorders. The most common TPM-related adverse reactions are associated with the central nervous system. A 20 year-old man experienced acute-onset mental status changes while receiving phenytoin (PHT), valproic acid (VPA), and TPM. He required sedative hypnotic therapy while TPM was weaned. The mental status changes were likely secondary to the carbonic anhydrase inhibitory effects of TPM, since the patient also had hyperchloremic metabolic acidosis. These mental status changes secondary to TPM are unusual since they were not associated with recent dosage titration or a high daily dose of TPM.
Mental status changes and metabolic acidosis may occur with topiramate therapy. These adverse events were reported during dosage titration and with high dosages of the drug. A 20-year-old man receiving topiramate, valproic acid, and phenytoin experienced acute-onset mental status changes with hyperchloremic metabolic acidosis. He had been receiving a modest dose of topiramate for 9 months. He was weaned off topiramate over 5 days, and his mental status returned to baseline within 48 hours of discontinuing the agent. This case illustrates the need for close evaluation of patients who experience acute-onset mental status changes during topiramate therapy.
Alteration of mental status is the most common adverse effect associated with anticonvulsant therapy. Topiramate (TPM) is a relatively new anticonvulsant given for adjunctive treatment of refractory partial seizure disorders. The most common TPM-related adverse reactions are associated with the central nervous system. A 20 year-old man experienced acute-onset mental status changes while receiving phenytoin (PHT), valproic acid (VPA), and TPM. He required sedative hypnotic therapy while TPM was weaned. The mental status changes were likely secondary to the carbonic anhydrase inhibitory effects of TPM, since the patient also had hyperchloremic metabolic acidosis. These mental status changes secondary to TPM are unusual since they were not associated with recent dosage titration or a high daily dose of TPM.
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