Chronic Diarrhea and Metabolic Acidosis Associated With Topiramate Use
Her vital signs were stable with blood pressure of 118/77 mm Hg, heart rate of 82 beats per minute, respiratory rate of 16 breaths per minute, temperature of 98°F, and oxygen saturation at room air of 100%. Physical examination showed limited active range of motion on the left shoulder and right hip because of pain; no overt signs of trauma or neurologic deficits were appreciated. The rest of physical evaluation was unremarkable.
Laboratory investigation was significant for a serum chloride of 114 mEq/L, bicarbonate of 16 mEq/L, potassium of 3.8 mEq/L, blood urea nitrogen of 15 mg/dL, creatinine of 0.8 mg/dL, and glucose of 104 mg/dL. Venous pH was 7.37. Hemoglobin was 13.1 g/dL and white blood cells was 10,000 mm3. Urine electrolytes showed sodium of 18 mmol/L, potassium of 27.5 mmol/L, and chloride of 29 mmol/L. Urine pH was 6.5. Skeletal x-rays were negative for fractures or osteoporosis.