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KMID : 0391520160240030116
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Journal of the Korean Child Neurology Society
2016 Volume.24 No. 3 p.116 ~ p.121
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The Effect of Long-term Topiramate Treatment on Acid-base Balance in Children with Epilepsy
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Kim Ji-Yong
Lee Hoon-Sang
Yeon Gyu-Min
Kim Young-Mi
Lee Yun-Jin
Nam Sang-Ook
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Abstract
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Purpose: Topiramate (TPM) has several actions of mechanism, one of which is a weak inhibitor of carbonic anhydrase. There have been few case reports of metabolic acidosis (MA) and cross sectional studies about the effect on the acid-base balance (ABB) by TPM. The aim of this study is to analyse the effect of long-term TPM monotherapy on the acid-base status (ABS) and potential risk factors for aggravating MA in children with epilepsy.
Methods: Of the 128 children and adolescents treated with TPM for more than 1 year, we investigated 38 patients who had laboratory tests about ABS just before and 1 year after the administration of TPM. ABS was assessed as blood pH, bicarbonate, sodium, potassium, chloride and anion gap. Risk factors were analyzed by the comparison of blood pH and bicarbonate 1 year after the treatment and differences of blood pH and bicarbonate between pre-treatment and after treatment according to potential clinical and laboratory variables.
Results: Blood pH (7.38±0.03 vs 7.36±0.02 P<0.001) and bicarbonate (23.4±2.25 vs 21.9±0.02 mEg/L, P=0.001) decreased after treatment. Blood pH after treatment was significantly lower in the group with higher dosage of TPM (P=0.049) and lower baseline pH (P=0.048). The change of blood pH and bicarbonate before and after the treatment was higher in the group of lower baseline bicarbonate (P=0.015).
Conclusion: Long-term treatment with TPM had the tendency toward MA without complete compensation in ABB. Most patients may continue to be treated without clinical manifestation by MA. However, careful monitoring for ABB is recommended during surgery or acute illness for the patients especially with high dosage and baseline low bicarbonate.
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KEYWORD
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Topiramate, Metabolic acidosis, Pediatric, Epilepsy
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