title: Acetazolamide in critically ill neonates and children with metabolic alkalosis.
abstract: BACKGROUND
  Acetazolamide is an option for hypochloremic metabolic alkalosis, but there are limited reports in children.
  
  
  OBJECTIVE
  To describe the acetazolamide regimen and outcomes in critically ill children with metabolic alkalosis.
  
  
  METHODS
  This was a descriptive, retrospective study of patients <18 years of age who received ≥3 doses of acetazolamide for metabolic alkalosis (ie, pH > 7.45 and bicarbonate [HCO3] > 26 mEq/L). Patients receiving other treatments for metabolic alkalosis within 24 hours of acetazolamide were excluded. The primary objective was to identify the mean dose and duration of acetazolamide. Secondary objectives were to determine the number of patients with treatment success (ie, serum HCO3 22-26 mEq/L) and occurrence of adverse events.
  
  
  RESULTS
  Thirty-four patients were included for analysis, the median age was 0.25 years (range = 0.05-12 years). The acetazolamide regimen included a mean dose of 4.98 ± 1.14 mg/kg for a mean number of 6.1 ± 5.3 (range = 3-24) doses. The majority (70.6%) received acetazolamide every 8 hours. Treatment success was achieved in 10 (29.4%) patients. Statistically significant differences were noted between the pre-acetazolamide and post-acetazolamide pH and HCO3, 7.51 ± 0.05 versus 7.37 ± 0.05 (P < .001) and 39.4 ± 6.1 mEq/L versus 31.4 ± 7.5 mEq/L (P < .001), respectively.
  
  
  CONCLUSIONS
  This is the first study to evaluate acetazolamide dosing for metabolic alkalosis in children with and without cardiac disease. Acetazolamide treatment resulted in improved HCO3, but the majority of patients did not achieve our definition of treatment success. Future studies should elucidate the optimal acetazolamide regimen.
authors.affiliation: University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
authors.forename: Megan G
authors.initials: MG
authors.lastname: Andrews
authors.forename: Peter N
authors.initials: PN
authors.lastname: Johnson
authors.forename: Erin M
authors.initials: EM
authors.lastname: Lammers
authors.forename: Donald L
authors.initials: DL
authors.lastname: Harrison
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Miller
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage*; D000471:Alkalosis / Q000188:drug therapy*; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide
keywords: acetazolamide; critically ill; metabolic alkalosis; neonate; pediatric