title: Acetazolamide for the management of chronic metabolic alkalosis in neonates and infants.
abstract: In this study, we evaluated the efficacy and safety of acetazolamide in the management of chronic metabolic alkalosis in neonates and infants with chronic respiratory insufficiency. A retrospective chart review of 90 patients treated with acetazolamide between 2006 and 2007 admitted to the neonatal intensive care unit was performed. Blood gases and electrolytes obtained at baseline and by 24 hours after acetazolamide administration were compared. Compared with baseline and after 24 hours of acetazolamide, mean measured serum bicarbonate (29.5±3.7 vs. 26.9±3.8 mEq/L, P<0.001) and base excess (10.0±3.4 vs. 4.8±4.0 mEq/L, P<0.001) were significantly lower. No significant differences in other electrolytes, blood urea nitrogen, and urine output were noted, except for an increased serum chloride and creatinine. Uncompensated respiratory acidosis developed in 4 (3.1%) treatment courses. Acetazolamide may be effective in decreasing serum bicarbonate in carefully selected patients. Its use and safety as an adjunctive therapy for chronic metabolic alkalosis in neonates and infants with chronic respiratory insufficiency needs further study.
authors.affiliation: 1The Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children's Hospital Los Angeles and the LAC + USC Medical Center, University of Southern California Keck School of Medicine 2University of Southern California School of Pharmacy 3Department of Pharmacy, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Tam
authors.forename: Annie
authors.initials: A
authors.lastname: Chhay
authors.forename: Lilly
authors.initials: L
authors.lastname: Yen
authors.forename: Linda
authors.initials: L
authors.lastname: Tesoriero
authors.forename: Rangasamy
authors.initials: R
authors.lastname: Ramanathan
authors.forename: Istvan
authors.initials: I
authors.lastname: Seri
authors.forename: Philippe S
authors.initials: PS
authors.lastname: Friedlich
mesh_terms: D000086:Acetazolamide / Q000009:adverse effects / Q000627:therapeutic use*; D000471:Alkalosis / Q000188:drug therapy* / Q000209:etiology; D001639:Bicarbonates / Q000097:blood; D002257:Carbonic Anhydrase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004573:Electrolytes / Q000378:metabolism; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012131:Respiratory Insufficiency / Q000150:complications*; D012189:Retrospective Studies
chemical_list: D001639:Bicarbonates; D002257:Carbonic Anhydrase Inhibitors; D004573:Electrolytes; D000086:Acetazolamide