Normal anion gap metabolic acidosis secondary to topiramate intake: case report
Introduction: Topiramate is a drug used to treat various types of epilepsy and as prophylaxis in cases of migrainous headache. One of its mechanisms of action is the inhibition of carbonic anhydrase in the kidney that triggers the excretion of alkaline urine resulting in metabolic acidosis. Case pre...
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| Format: | Article |
| Language: | English |
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Universidad Nacional de Colombia
2018-07-01
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| Series: | Case Reports |
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| Online Access: | https://revistas.unal.edu.co/index.php/care/article/view/69710 |
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| author | Jorge Fernando Miño-Bernal Luis Eduardo Alcaraz-Díaz Sergio Zamora-Gómez Angela Cristina Montenegro-Ibarra |
| author_facet | Jorge Fernando Miño-Bernal Luis Eduardo Alcaraz-Díaz Sergio Zamora-Gómez Angela Cristina Montenegro-Ibarra |
| author_sort | Jorge Fernando Miño-Bernal |
| collection | DOAJ |
| description | Introduction: Topiramate is a drug used to treat various types of
epilepsy and as prophylaxis in cases of migrainous headache. One of its mechanisms of action is the inhibition of carbonic anhydrase in the kidney that triggers the excretion of alkaline urine resulting in metabolic acidosis. Case presentation: 17-year-old female patient from Mexico City who regularly uses topiramate, quetiapine and sertraline for the management of depressive disorder. She developed normal anion gap metabolic acidosis secondary to topiramate intake. As a result, she required invasive ventilatory support due to reduced consciousness and respiratory distress. Adequate response to management with laxatives and bicarbonate was achieved, with full renal and neurological recovery. Discussion: Metabolic acidosis is the most common acid-base disorder observed in clinical practice. The difference between measurable cations and anions, known as anion gap, helps to classify the severity of acidosis. Bicarbonate losses or renal tubular disorders generate normal anion gap acidosis as opposed to acidosis resulting from an overproduction of endogenous acid or renal failure, which causes high anion gap. Topiramate is a little known cause of normal anion gap metabolic acidosis; by inhibiting carbonic anhydrase, it causes mixed renal tubular acidosis or type 3 acidosis, as a consequence of the inability to secrete hydrogen ions in the collecting tubule, and a limitation of bicarbonate reabsorption in the proximal tubule. Conclusion: Topiramate, either in therapeutic doses or in overdose, can lead to normal anion gap metabolic acidosis due to the inhibition of carbonic anhydrase in the kidneys. It is usually reversible after starting bicarbonate. |
| first_indexed | 2024-04-12T09:02:37Z |
| format | Article |
| id | doaj.art-60477cb8f54b4f688058af8b44b59add |
| institution | Directory Open Access Journal |
| issn | 2462-8522 |
| language | English |
| last_indexed | 2024-04-12T09:02:37Z |
| publishDate | 2018-07-01 |
| publisher | Universidad Nacional de Colombia |
| record_format | Article |
| series | Case Reports |
| spelling | doaj.art-60477cb8f54b4f688058af8b44b59add2022-12-22T03:39:11ZengUniversidad Nacional de ColombiaCase Reports2462-85222018-07-014212613610.15446/cr.v4n2.6971049169Normal anion gap metabolic acidosis secondary to topiramate intake: case reportJorge Fernando Miño-BernalLuis Eduardo Alcaraz-DíazSergio Zamora-GómezAngela Cristina Montenegro-IbarraIntroduction: Topiramate is a drug used to treat various types of epilepsy and as prophylaxis in cases of migrainous headache. One of its mechanisms of action is the inhibition of carbonic anhydrase in the kidney that triggers the excretion of alkaline urine resulting in metabolic acidosis. Case presentation: 17-year-old female patient from Mexico City who regularly uses topiramate, quetiapine and sertraline for the management of depressive disorder. She developed normal anion gap metabolic acidosis secondary to topiramate intake. As a result, she required invasive ventilatory support due to reduced consciousness and respiratory distress. Adequate response to management with laxatives and bicarbonate was achieved, with full renal and neurological recovery. Discussion: Metabolic acidosis is the most common acid-base disorder observed in clinical practice. The difference between measurable cations and anions, known as anion gap, helps to classify the severity of acidosis. Bicarbonate losses or renal tubular disorders generate normal anion gap acidosis as opposed to acidosis resulting from an overproduction of endogenous acid or renal failure, which causes high anion gap. Topiramate is a little known cause of normal anion gap metabolic acidosis; by inhibiting carbonic anhydrase, it causes mixed renal tubular acidosis or type 3 acidosis, as a consequence of the inability to secrete hydrogen ions in the collecting tubule, and a limitation of bicarbonate reabsorption in the proximal tubule. Conclusion: Topiramate, either in therapeutic doses or in overdose, can lead to normal anion gap metabolic acidosis due to the inhibition of carbonic anhydrase in the kidneys. It is usually reversible after starting bicarbonate.https://revistas.unal.edu.co/index.php/care/article/view/69710TopiramateAnticonvulsantsRenal tubular acidosisCarbionic anhydraseIntoxication. |
| spellingShingle | Jorge Fernando Miño-Bernal Luis Eduardo Alcaraz-Díaz Sergio Zamora-Gómez Angela Cristina Montenegro-Ibarra Normal anion gap metabolic acidosis secondary to topiramate intake: case report Case Reports Topiramate Anticonvulsants Renal tubular acidosis Carbionic anhydrase Intoxication. |
| title | Normal anion gap metabolic acidosis secondary to topiramate intake: case report |
| title_full | Normal anion gap metabolic acidosis secondary to topiramate intake: case report |
| title_fullStr | Normal anion gap metabolic acidosis secondary to topiramate intake: case report |
| title_full_unstemmed | Normal anion gap metabolic acidosis secondary to topiramate intake: case report |
| title_short | Normal anion gap metabolic acidosis secondary to topiramate intake: case report |
| title_sort | normal anion gap metabolic acidosis secondary to topiramate intake case report |
| topic | Topiramate Anticonvulsants Renal tubular acidosis Carbionic anhydrase Intoxication. |
| url | https://revistas.unal.edu.co/index.php/care/article/view/69710 |
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