Abstract
Topiramate is a potent antiepileptic drug with multiple modes of action including inhibition of carbonic anhydrase activity. Inhibition of this enzyme predisposes to non-anion gap metabolic acidosis which has been amply described in the literature. However, the severity is yet to be well defined. We encountered a case of topiramate-induced non-anion gap metabolic acidosis associated with hemodynamic perturbations in an 8-year-old child in the postoperative period.