Severe anemia of unexpected cause in a female teenager

Abstract

Introduction: In pediatric practice topiramate is used alone or with other medicines to treat certain types of seizures and to prevent migraine headaches in adolescents 12 years and older. Clinical case: A14 years-old female was admitted into the ER Unit after voluntary ingestion of 30 capsules (3000 mg) of topiramate. The drug was prescribed by her neurologist for migraines; the suicidal attempt was determined by a conflict with her mother. At admission she had dizziness, drowsiness, speech disturbances,abnormal coordination, vomiting and abdominal pain. Laboratory data showed severe anemia (Hb=4,3 g/dl), normochrome and normocytic, severe metabolic acidosis(HCO3 - = 6,6 mEq/L), hypoglycemia (37 mg/dl), hypercloremia(Cl-=121,7 mEq/L), hypernatremia (Na+= 150 mEq/L),hypokalemia (K+ =1,71 mEq/L). The treatment included gastric lavage, activated charcoal, intravenous fluids, bicarbonate and blood transfusions. The clinical status improved within 24 hours, Hb level raise to 13,8 g/dl and no other laboratory abnormalities were found. The medical records of the patient showed she has no anemia previously. A CT scan performed in order to exclude an organic cause for her headaches was normal. The patient was dismissed after 10 days in good general condition; she presented mild epigastric pain and leave the hospital with proton-pump inhibitor and pshychologic counceling recommendations. Subsequently she had several hospitalisations for depression and suicidary thoughts treated with sertraline and she is followed by a pediatric psychiatrist. Conclusions: This is a particular case of voluntary topiramate intoxication with particular side effects as severe anemia and metabolic disturbances, followed by long-term behavioral consequences.