Observation and patient disposition after topiramate poisoning

Admit patients with topiramate poisoning to an intensive care unit if they have severe metabolic acidosis requiring intravenous sodium bicarbonate therapy or haemodialysis.

Admit patients with toxic effects due to topiramate poisoning until these have resolved.

Discharge patients if they remain asymptomatic for at least 6 hours after ingestion.

Medical observation is recommended for drug-naive children who have accidentally ingested more than 10 mg/kg of topiramate. Drug-naive children who have accidentally ingested less than 10 mg/kg of topiramate can be discharged if they are asymptomatic and can be supervised in a safe environment.

Sedative drugs can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after discharge.