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Remember: 850mg/L: greatest risk for serious or life-threatening effects including coma, respiratory depression, metabolic acidosis, hypotension Ammonia levels: may be helpful in predicting presence of underlying encephalopathy and/or development of cerebral oedema in patients who are mechanically ventilated and sedated (Clay and Hainline, 2007) The ICU resident now wants to know: Are we going to dialyse this patient

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In vitro study found that topiramate increased MDA, NO and ROS production in astrocytes, showing a dose-dependent negative effect (Pavone and Cardile, 2003)