A 30-year-old woman with epilepsy is started on topiramate. She complains of tingling in her fingers and toes. Which metabolic complication is she at increased risk for?
- A Hypokalemia
- B Metabolic acidosis ✓
- C Hypercalcemia
- D Respiratory alkalosis
Correct answer: B. Metabolic acidosis
Explanation
Topiramate is a weak carbonic anhydrase inhibitor. It causes renal bicarbonate wasting, leading to a hyperchloremic metabolic acidosis. The same mechanism produces paresthesias and increases the risk of nephrolithiasis. Serum bicarbonate levels should be checked periodically.
Reference: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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