[Efficacy of acetazolamide treatment of patients with hypercapnia and superimposed metabolic alkalosis].
BACKGROUND
Metabolic alkalosis usually complicates the evolution of patients with hypercapnia under diuretic or steroid therapy. The objective of this study was to analyze the efficiency of therapy with acetazolamide, a reversible carbonic anhydrase inhibitor, in this condition.


METHODS
Prospective study conducted at our hospital from June 1994 to March 1996, with 45 patients who had chronic respiratory acidosis and metabolic alkalosis. After a previous stabilization of the patient and eventually the discontinuation of diuretic or corticosteroid drugs fro 24-48 hours, 500 or 750 mg of acetazolamide were administered daily for 48 hours. Later, variations both in arterial gasometry and venous electrolytes were analyzed by comparing two means of paired data.


RESULTS
After therapy with acetazolamide a clinical improvement was observed in patients, a decrease in PaCO2, pH and CO3H (p < 0.001) and an increase in PaO2 (p < 0.001). Hypochloremia (82.2%) and hypopotassemia (33.3%) were the most common electrolytic abnormalities before therapy. Both abnormalities improved significantly after the administration of acetazolamide. In five patients (11.1%) acetazolamide was discontinued when metabolic acidosis appeared, which only in three cases was associated with acidemia. No secondary effects were observed.


CONCLUSIONS
Acetazolamide is an efficient alternative for treatment of patients with respiratory acidosis and metabolic alkalosis, particularly when other more common measures in this condition (discontinuation of diuretics and/or volemic replacement) have failed or are contraindicated. On the other hand, the emergence of relevant secondary effects is unlikely.
Prieto de Paula
J M
JM
Servicio de Medicina Interna, Hospital Santos Reyes, Aranda de Duero, Burgos.
Villamandos Nicás
V
V
Cancelo Suárez
P
P
del Portillo Rubí
A
A
Guillem Ares
E
E
Prada Mínguez
A
A
Sanz de la Fuente
H
H
D000086:Acetazolamide / Q000008:administration & dosage / Q000627:therapeutic use*; D000136:Acid-Base Equilibrium; D000142:Acidosis, Respiratory / Q000188:drug therapy; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000471:Alkalosis / Q000139:chemically induced / Q000188:drug therapy*; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D002712:Chlorides / Q000097:blood; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012964:Sodium / Q000097:blood; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D002257:Carbonic Anhydrase Inhibitors; D002712:Chlorides; D004232:Diuretics; D012964:Sodium; D000086:Acetazolamide; D011188:Potassium
Eficacia del tratamiento con acetazolamida en pacientes con hipercapnia y alcalosis metabólica sobreimpuesta.