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Topamax Metabolic Acidosis Symptoms

Topiramate Induces Type 3 Renal Tubular Acidosis By Inhibiting Renal Carbonic Anhydrase

Topiramate Induces Type 3 Renal Tubular Acidosis By Inhibiting Renal Carbonic Anhydrase

Topiramate induces type 3 renal tubular acidosis by inhibiting renal carbonic anhydrase Nephrology Dialysis Transplantation, Volume 21, Issue 10, 1 October 2006, Pages 29952996, Anne Sacr, Franois Jouret, Daniel Manicourt, Olivier Devuyst; Topiramate induces type 3 renal tubular acidosis by inhibiting renal carbonic anhydrase, Nephrology Dialysis Transplantation, Volume 21, Issue 10, 1 October 2006, Pages 29952996, We report a case of mixed (type 3) renal tubular acidosis (RTA) associated with the anti-convulsant drug topiramate used for migraine prophylaxis. A 47-year-old woman treated with topiramate (150 mg/day) since 12 months for invalidating migraine was referred for a metabolic acidosis evidenced in a routine blood sampling. She complained of muscle weakness and bone pain. Clinical examination showed weight loss (6 kg in 4 months) and joint sensitivity. Blood analyses confirmed a mild hyperchloraemic metabolic acidosis (plasma , 19.0 mEq/l; plasma anion gap, 8 mEq/l) with hypokalaemia (3.2 mEq/l) and normal renal function. Plasma before topiramate administration was normal. The urine pH was 6.0 with a positive urinary anion gap (UAG, +39 mEq/day), positive 2 -microglobulinuria (2.1 mg/l) and a low urinary citrate excretion (0.7 mM/24... The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: [email protected] Continue reading >>

Topamax Disease Interactions - Drugs.com

Topamax Disease Interactions - Drugs.com

Carbonic Anhy. Inhibitors (Includes Topamax) Bone Marrow Depression/Blood Dyscrasias Severe Potential Hazard, Moderate plausibility Applies to: History - Blood Dyscrasias, Bone Marrow Depression/Low Blood Counts The use of carbonic anhydrase inhibitors may rarely cause bone marrow suppression and blood dyscrasias at recommended dosages. Aplastic anemia, thrombocytopenia or thrombocytopenia purpura, leukopenia, agranulocytosis, and hemolytic anemia have been reported. Extreme caution should be exercised if carbonic anhydrase inhibitors are administered to patients with these preexisting conditions. A baseline CBC and platelet count is recommended, as well as monitoring at regular intervals during therapy. McWhae JA, Chang J, Lipton JH "Drug-induced fatal aplastic anemia following cataract surgery." Can J Ophthalmol 27 (1992): 313-5 Lubeck MJ "Aplastic anemia following acetazolamide therapy." Am J Ophthalmol 69 (1970): 684-5 Rentiers PK, Johnston AC, Buskard N "Severe aplastic anemia as a complication of acetazolamide therapy." Can J Ophthalmol 5 (1970): 337-42 Keisu M, Wiholm BE, Ost A, Mortimer O "Acetazolamide-associated aplastic anaemia." J Intern Med 228 (1990): 627-32 Englund GW "Fatal pancytopenia and acetazolamide therapy." JAMA 210 (1969): 2282 Gangitano JL, Foster SH, Contro RM "Nonfatal methazolamide-induced aplastic anemia." Am J Ophthalmol 86 (1978): 138-9 "Product Information. Diamox (acetazolamide)." Lederle Laboratories, Wayne, NJ. Wisch N, Fischbein FI, Siegel R, Glass JL, Leopold I "Aplastic anemia resulting from the use of carbonic anhydrase inhibitors." Am J Ophthalmol 75 (1973): 130-2 Kristinsson A "Fatal reaction to acetazolamide." Br J Ophthalmol 51 (1967): 348-9 Carbonic Anhydrase Inhibitor Anticonvulsants (Includes Topamax) Oligohidrosis/Hyperthe Continue reading >>

Topamax Precautions And Warnings

Topamax Precautions And Warnings

Join the conversation. register now or log in Topamax can have a drug interaction with other medicines or not be a good drug for you if you have certain medical conditions. Its important to know all of the medicines that you or your family member takes. Use the migraine journal to keep a list of all medicines to share with your doctor. Only your doctor can prescribe prescription medicines for you. Do not stop taking any medicine without speaking to your doctor. Topamax can cause serious side effects including: Hyperammonemia (high levels of ammonia in the blood) Metabolic acidosis (increased acid levels in the body) Encephalopathy (brain disease, damage, or other problems) Secondary angle closure glaucoma (fluid buildup inside of the eye, which can lead to blindness) Sudden problems with vision (difficulty seeing clearly) Learn about Topamax and Serious Eye Problems (including Open Angle Glaucoma) Have an extreme sensitivity to topiramate (the active ingredient in Topamax formulations). This could lead to reactions from severe itching and hives to potentially deadly shock. Topamax should be used with caution if you: Have or have had kidney problems, including kidney stones People with these conditions or circumstances may need to take a lower dose of Topamax or take special tests to use Topamax safely. CAUTION: Do not suddenly stop taking Topamax. This may cause serious health problems or side effects such as increase or return of seizures. Topamax should be withdrawn gradually by reducing the dose at weekly intervals if the decision is made by the physician to discontinue therapy. Taking Topamax may increase the possibility of your developing kidney stones. It may also increase your risk of developing metabolic acidosis (when the kidneys arent removing enough acid fro Continue reading >>

Topiramate And Severe Metabolic Acidosis: Case Report

Topiramate And Severe Metabolic Acidosis: Case Report

Topiramate infrequently induces anion gap metabolic acidosis through carbonic anhydrase inhibition on the distal tubule of the nephron - a type 2 renal tubular acidosis. We report on a 40 years old woman previously healthy that developed significant asymptomatic metabolic acidosis during topiramate therapy at a dosage of 100mg/day for three months. Stopping medication was followed by normalization of the acid-base status within five weeks. This infrequent side effect appears unpredictable and should be given careful attention. Key words: topiramate, metabolic acidosis, carbonic anhydrase inhibitor. Topiramato pode produzir raramente uma acidose metablica atravs da inibio da anidrase carbnica no tbulo distal do nfron - acidose tubular renal do tipo 2. Relatamos o caso de mulher de 40 anos previamente saudvel que desenvolveu quadro de acidose metablica assintomtica grave, sem outra etiologia identificvel, durante uso de topiramato na dose de 100mg/dia por trs meses. Este efeito colateral, embora infrequente, parece ser imprevisvel e requer ateno cuidadosa. Palavras-chave: topiramato, acidose metablica, inibidor da anidrase carbnica. Topiramate was approved by the FDA (US - Food and Drug Administration) in 1996 for clinical use as an anticonvulsant drug. Since then, other clinical indications have been studied, such as the treatment of bipolar disorder, or neuropathic pain syndromes relief1,2, and migraine and cluster headache3-5. As a consequence, it is likely that clinical use will tend to expand progressively. Initially, significant adverse reactions to topiramate were related to the central nervous system (somnolence, nervousness, psychomotor slowing, memory problems, fatigue), or were gastrointestinal (nausea), ocular (diplopia, nystagmus) and neuromuscular (tremor, Continue reading >>

Topamax (topiramate) - Side Effects, Dosage, Interactions - Drugs

Topamax (topiramate) - Side Effects, Dosage, Interactions - Drugs

Topamax is the brand name of topiramate, an anticonvulsant drug used to prevent seizures and reduce the frequency of migraines . While its exact mechanism of action is unknown, studies suggest Topamax might alter the production or action of neurotransmitters in the brain, suppressing the abnormal activity of the nerves in the brain that cause seizures or preventing the abnormal activity from spreading to other nerves. Other research has suggested that it might suppress the nerves directly, thereby making them less likely to fire. The Food and Drug Administration (FDA) approved Topamax to treat seizures in 1996. In 2004, Topamax received FDA approval for the prevention of migraines. Manufactured by Janssen Pharmaceuticals, Topamax is now the number-one prescribed medication for migraine prevention in the United States. It's used to stop migraine headaches from occurring in those 12 and older. It cannot be used to treat a headache that has already begun, but it may help to reduce the number of painful migraine. Doctors occasionally prescribe Topamax off-label to control binging and purging and promote weight loss in people with eating disorders such as bulimia nervosa and binge-eating disorder. The drug is seen as an alternative when first-line therapy with selective serotonin reuptake inhibitors (SSRIs) have failed to achieve results. It is unclear why Topamax is effective for these uses; however, it is believed that the same properties that enable it to control migraines and seizures also work to inhibit the brain networks that cause food cravings. Although there have been a number of studies supporting the efficacy of Topamax for weight loss, there remain some concerns regarding its long-term safety. In addition, the drug has troubling, sometimes serious side effects. Continue reading >>

Effect Of Topiramate On Acidbase Balance: Extent, Mechanism And Effects

Effect Of Topiramate On Acidbase Balance: Extent, Mechanism And Effects

Effect of topiramate on acidbase balance: extent, mechanism and effects 1Departments of Pharmacology, The University of Liverpool, Liverpool, UK 2Departments of Neurological Sciences, The University of Liverpool, Liverpool, UK 1Departments of Pharmacology, The University of Liverpool, Liverpool, UK 2Departments of Neurological Sciences, The University of Liverpool, Liverpool, UK Professor Munir Pirmohamed, Department of Pharmacology, The University of Liverpool, Ashton Street, Liverpool L69 3GE, UK. Tel: + 44 151 794 5549 Fax: + 44 151 794 5540 E-mail: [email protected] Received 2009 Apr 2; Accepted 2009 Jul 27. Copyright Journal compilation 2009 The British Pharmacological Society This article has been cited by other articles in PMC. Topiramate is licensed for the treatment of epilepsy and for migraine prophylaxis, but is also used off-licence for a wide range of indications. With the increasing use of topiramate, reports have emerged that topiramate can cause metabolic acidosis in some patients. It does this by impairing both the normal reabsorption of filtered HCO3 by the proximal renal tubule and the excretion of H+ by the distal renal tubule. This combination of defects is termed mixed renal tubular acidosis (RTA). The mechanism involves the inhibition of the enzyme carbonic anhydrase, which is consistent with the fact that genetic deficiency of carbonic anhydrase is associated with mixed RTA. Topiramate-induced RTA can make patients acutely ill, and chronically, can lead to nephrolithiasis, osteoporosis and, in children, growth retardation. There is no proven method for predicting or preventing the effect of topiramate on acidbase balance, but patients with a history of renal calculi or known RTA should not receive topiramate. The utility of regular monitoring of Continue reading >>

Topamax Metabolic Acidosis

Topamax Metabolic Acidosis

Vibration from poorly designed systems or a change of service leading to high velocities, high pressure drop, or hammer. Wildlife walking on, landing on, defecating on, or steeling materials for a nest. Just plain old insulation well past its design life. UT reading locations where the mastic dries and cracks or plugs get weathered. API 570, the same inspection code that requires regular thickness readings, suggests that inspector pay particular attention to the location that have been tested before for this very reason. Once moisture gets under the protective shell, the same properties that makes the insulation perform well, which is holding air spaces then changes into a detriment. Once wet, most types of insulation have the properties that turn into a wicking function that hold moisture/water on the pipe surface that is the most vulnerable. Once the system has been infiltrated, every time it rains, a steam trap discharges onto the same location, water is used to cool the exterior of a system, or fire water lines are purged, the moisture travels to the same localized corroding location. Regular inspections attempt to and sometimes anticipate corrosion issues. However most (possibly all) CUI does not happen uniformly with a classroom/textbook metal loss but in one problem area. With high temperature systems (Above 250F average or 212F specific), the moisture vaporizes off. It still destroys the insulation properties from functioning properly but typically does not have a localized corrosion issue due to its temperature. The lower temperature situations have a different issue. The combination of moisture repeatedly relocating to the same spot with the heat is like a catalyst for accelerated corrosion, a frenzy if you will. It's the perfect condition for advanced accele Continue reading >>

Metabolic Acidosis

Metabolic Acidosis

Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea. Lactic acidosis results from a buildup of lactic acid. It can be caused by: Alcohol Cancer Exercising intensely Liver failure Medicines, such as salicylates Other causes of metabolic acidosis include: Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis) Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Continue reading >>

Topamax (topiramate): Side Effects, Interactions, Warning, Dosage & Uses

Topamax (topiramate): Side Effects, Interactions, Warning, Dosage & Uses

Topiramate is a sulfamate-substituted monosaccharide.TOPAMAX (topiramate) Tablets are available as 25 mg, 50 mg, 100 mg, and200 mg round tablets for oral administration. TOPAMAX (topiramatecapsules) Sprinkle Capsules are available as 15 mg and 25 mg sprinkle capsulesfor oral administration as whole capsules or opened and sprinkled onto softfood. Topiramate is a white crystalline powder with a bittertaste. Topiramate is most soluble in alkaline solutions containing sodiumhydroxide or sodium phosphate and having a pH of 9 to 10. It is freely solublein acetone, chloroform , dimethylsulfoxide, and ethanol . The solubility in wateris 9.8 mg/mL. Its saturated solution has a pH of 6.3. Topiramate has themolecular formula C12H21NO8S and a molecularweight of 339.36. Topiramate is designated chemically as 2,3:4,5- Di- O-isopropylidene--D-fructopyranosesulfamate and has the following structural formula: TOPAMAX Tablets contain the following inactiveingredients: carnauba wax, hypromellose, lactose monohydrate, magnesiumstearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80,pregelatinized starch, purified water, sodium starch glycolate, synthetic ironoxide, and titanium dioxide. TOPAMAX Sprinkle Capsules containtopiramate-coated beads in a hard gelatin capsule. The inactive ingredients areblack pharmaceutical ink, cellulose acetate, gelatin, povidone, sodium laurylsulfate, sorbitan monolaurate, sugar spheres (sucrose and starch) and titaniumdioxide. What are the possible side effects of topiramate (Topamax, Topamax Sprinkle, Topiragen)? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Report any new or worsening symptoms to your doctor, such as: mood or Continue reading >>

Renal Fellow Network: The Diet Pill And The Deadly Acidosis

Renal Fellow Network: The Diet Pill And The Deadly Acidosis

I was recently called to evaluate an obese patient with profound metabolic acidosis who was admitted to the hospital with change in mental status and poor oral intake for several days. Her admission labs revealed severe hyperglycemia (glucose 776 mg/dL) and normal anion gap hyperchloremic metabolic acidosis (serum pH of 7.11 and serum bicarbonate of 7 mmol/L). She was initially suspected as having diabetic ketoacidosis due to miscalculation of the anion gap by the admitting team who used the corrected serum sodium and not the actual sodium, and as expected, her acidosis did not resolve despite the correction of hyperglycemia with intravenous fluids and insulin. Her urine pH was 6.2, urine anion gap was 12 (no ketonuria) and fractional excretion of bicarbonate was 17% suggesting the possibility of mixed renal tubular acidosis. The case appeared like a puzzle until close questioning with the family revealed that her primary care physician had started the patient on topiramate (200mg/d) few weeks back for obesity. Interestingly, there has been a recent increase in literature about the risk of hyperchloremic metabolic acidosis in adult patients on topiramate therapy. Topiramate is primarily approved for use as an anticonvulsant in patients with partial and generalized seizures and for migraine prophylaxis but its use as an antiobesity drug is among the several off label" indications. In clinical trials , up to 32% of patients receiving topiramate 400mg/d in divided doses had evidence of normal anion gap metabolic acidosis and up to 7% had moderate to severe metabolic acidosis (less than 17 but greater than 5 mmol/L). So, how does topiramate cause hyperchloremic normal anion gap metabolic acidosis ? Carbonic anhydrase (CA) catalyzes the conversion of CO2 to HCO3- and H+ ion Continue reading >>

Long-term Side Effects Of Topiramate For Migraines

Long-term Side Effects Of Topiramate For Migraines

Long-Term Side Effects of Topiramate for Migraines Joanne Matthews is a pharmacist with more than 10 years experience in the pharmaceutical industry specializing in the collection and assessment of adverse drug reactions. She received her pharmacy degree from the University of Michigan and is a registered pharmacist in Illinois and Michigan. Woman with a headache holding her headPhoto Credit: michaeljung/iStock/Getty Images Topiramate (Topamax) is a medicine used to treat epilepsy and prevent migraines. It decreases overly active brain signaling and is used alone or combined with other antiepileptic medicines to treat seizures. Topiramate is also used to prevent migraine headaches. In addition to short-term side effects, topiramate may cause certain long-term side effects. Topiramate may cause metabolic acidosis, which is an acid-base imbalance in the body that increases the acidity of the blood. Your doctor may test your blood's bicarbonate level before and during treatment with topiramate to check for this side effect. Your risk of metabolic acidosis increases if you take additional medicines that are structured like topiramate, such as acetazolamide (Diamox). Following a high-fat and low-carbohydrate diet may also increase your risk for topiramate-related acidosis. If you develop metabolic acidosis, you may also experience kidney stones. Drinking 6 to 8 glasses of water each day helps prevent kidney stones. Metabolic acidosis may also cause loss of bone minerals, increasing your risk for fractures. Topiramate, as well as other antiepileptic medicines, may affect your mental health. You may have suicidal feelings, think about killing yourself or try to do so. This can happen within a week of starting topiramate or may take as long as 24 weeks after starting the medic Continue reading >>

What Is Metabolic Acidosis?

What Is Metabolic Acidosis?

Metabolic acidosis happens when the chemical balance of acids and bases in your blood gets thrown off. Your body: Is making too much acid Isn't getting rid of enough acid Doesn't have enough base to offset a normal amount of acid When any of these happen, chemical reactions and processes in your body don't work right. Although severe episodes can be life-threatening, sometimes metabolic acidosis is a mild condition. You can treat it, but how depends on what's causing it. Causes of Metabolic Acidosis Different things can set up an acid-base imbalance in your blood. Ketoacidosis. When you have diabetes and don't get enough insulin and get dehydrated, your body burns fat instead of carbs as fuel, and that makes ketones. Lots of ketones in your blood turn it acidic. People who drink a lot of alcohol for a long time and don't eat enough also build up ketones. It can happen when you aren't eating at all, too. Lactic acidosis. The cells in your body make lactic acid when they don't have a lot of oxygen to use. This acid can build up, too. It might happen when you're exercising intensely. Big drops in blood pressure, heart failure, cardiac arrest, and an overwhelming infection can also cause it. Renal tubular acidosis. Healthy kidneys take acids out of your blood and get rid of them in your pee. Kidney diseases as well as some immune system and genetic disorders can damage kidneys so they leave too much acid in your blood. Hyperchloremic acidosis. Severe diarrhea, laxative abuse, and kidney problems can cause lower levels of bicarbonate, the base that helps neutralize acids in blood. Respiratory acidosis also results in blood that's too acidic. But it starts in a different way, when your body has too much carbon dioxide because of a problem with your lungs. Continue reading >>

Topiramate (topamax, Trokendi Xr)

Topiramate (topamax, Trokendi Xr)

Worst Pills, Best Pills Newsletter Articles Search results below include Worst Pills, Best Pills Newsletter Articles where your selected drug is a primary subject of discussion Illegal Promotion of a Drug That Causes Birth Defects [ hide all summaries ] Find out why Johnson & Johnson was recently criminally prosecuted for illegally promoting an epilepsy drug that clearly causes birth defects. Drug-induced Cognitive Impairment: Part 2: Delirium and Dementia [ hide all summaries ] This second article about drug-induced dementia or delirium lists and discusses an additional 79 drugs that can cause these reversible kinds of mental deterioration. The two articles collectively review 136 drugs that can cause these serious side effects, especially in older people. Drug-Induced Eye Toxicity: 62 Drugs That Can Cause Eye Disease [ hide all summaries ] This article, based on a recent review in Drug Safety, lists 62 prescription drugs that can cause eye disease. The range of drug-induced eye diseases includes diseases of the eyelids, glaucoma, cataracts, retinal damage and optic nerve damage. As is true for drug-induced diseases in other parts of the body, you should consider newly developed eye symptoms beginning shortly after starting a new medication to be possibly drug-induced and consult a physician. Taking TOPAMAX to Treat Alcoholism Could Have Serious Consequences [ hide all summaries ] A recent drug industry-funded study was widely hailed as showing that TOPAMAX, a drug approved for seizures and migraines, worked well in treating alcoholism in heavy drinkers. However, upon closer inspection, the study does not convincingly prove the safety or effectiveness of the new suggested use of topiramate. The use of the drug produced only a modest decrease in the percentage of days Continue reading >>

Archived - Topamax* (topiramate) Use Is Associated With Metabolic Acidosis - Janssen-ortho Inc.

Archived - Topamax* (topiramate) Use Is Associated With Metabolic Acidosis - Janssen-ortho Inc.

This is duplicated text of a letter from Janssen-Ortho Inc. Contact the company for a copy of any references, attachments or enclosures. Important drug safety information - TOPAMAX* (topiramate) use is associated with Metabolic Acidosis Janssen-Ortho Inc., following discussions with Health Canada, would like to inform you of emerging important safety information which indicates that TOPAMAX * (topiramate) tablets and sprinkle capsules cause hyperchloremic, non-anion gap metabolic acidosis (decreased serum bicarbonate). TOPAMAX * is approved and marketed as adjunctive therapy for the management of patients (adults and children two years and older) with epilepsy who are not satisfactorily controlled with conventional therapy. Data on hyperchloremic, non-anion gap metabolic acidosis are derived from placebo-controlled trials and post-marketing experience in over 2.5 million patients. In clinical trials, the rate of occurrence of a persistently decreased serum bicarbonate ranges from 23-67% for patients treated with topiramate and 1-10% for placebo. The incidence of markedly low serum bicarbonate in clinical trials ranges from 3-11% for topiramate and 0 to less than 1% for placebo. Generally, decreases in serum bicarbonate occur soon after initiation of topiramate, although they can occur at any time during treatment. Bicarbonate decrements are usually mild-moderate, with an average decrease of 4 mEq/L at daily doses of 400 mg in adults and approximately 6 mg/kg/day in pediatric patients. Rarely, patients can experience decrements to values below 10 mEq/L. Conditions or therapies that predispose to acidosis (such as renal disease, severe respiratory disorders, status epilepticus, diarrhea, surgery, ketogenic diet, or drugs) may be additive to the bicarbonate lowering effec Continue reading >>

Hyperchloremic, Normal Anion-gap, Metabolic Acidosis Due To Topiramate

Hyperchloremic, Normal Anion-gap, Metabolic Acidosis Due To Topiramate

Hyperchloremic, Normal Anion-Gap, Metabolic Acidosis Due to Topiramate Kathryn D. Mathews, PharmD; Jennifer E. Stark, PharmD, BCPS Am J Health Syst Pharm.2008;65(15):1430-1434. The metabolic adverse effects of topiramate have been well documented in the pediatric population,[ 4 , 5 ] but case reports in the adult population are limited.[ 6 , 7 , 8 , 9 , 10 , 11 ] Published reports that evaluated topiramate-associated hyperchloremic, normal anion-gap, metabolic acidosis were identified via a MEDLINE search (1966-May 2007) and included six cases in adults. Search terms included topiramate, metabolic acidosis, Topamax, and hyperchloremia. The first case involved a 22-year-old mentally handicapped man with a history of recurrent respiratory infections who developed metabolic acidosis after four months of taking topiramate 800 mg daily for Lennox-Gastaut syndrome.[ 6 ] The patient had symptoms of fatigue, lethargy, hypotonia, and hyperventilation. His arterial blood gas revealed a pH of 7.3 (reference range, 7.35-7.45), and his serum bicarbonate concentration was 19 meq/L (reference range, 22-26 meq/L). Metabolic acidosis resolved after withdrawal of topiramate, although the authors did not report details of the timeline to resolution. Wilner et al.[ 7 ] reported the development of metabolic acidosis in a 52-year-old man taking topiramate 200 mg daily for partial complex seizures. The patient developed metabolic acidosis while undergoing a right temporal lobectomy for intractable seizures. He reported no symptoms of metabolic acidosis prior to surgery, but did report one to two weeks of diarrhea preceding the day of surgery. On the day of surgery, his metabolic acidosis was evidenced by an arterial blood gas pH of 7.29 (reference range, 7.35-7.45) and a serum bicarbonate co Continue reading >>

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