Clinical presentation

Effects of topiramate poisoning include:

• central nervous system (CNS) effects
  • CNS depression—altered conscious state ranging from drowsiness to coma
  • ataxia, dysarthria, seizures including status epilepticus
  • hallucinations have been reported in children
• metabolic effects—non–anion gap (hyperchloraemic) metabolic acidosis via carbonic anhydrase inhibition
• cardiovascular effects—hypotension.

Topiramate is renally excreted, so kidney failure or impairment can prolong toxicity.