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Acetazolamide: Effects on ion conc

Acetazolamide is a carbonic anhydrase inhibitor that results in a metabolic acidosis. Metabolic acidosis triggers an increased respiratory drive with decreased pCO2 in order to compensate for decreased in [HCO3-].

Acetazolamide reduces hydrogen ion secretion and increases the excretion of bicarbonate, sodium, potassium and water at the renal tubule. Therefore, it creates a decrease in the serum concentration of potassium and sodium. Due to the reduction in sodium concentration without a concomitant reduction in the chloride concentration, the strong ion difference (SID = ([Na+] + [K+] + [Ca2+] + [MG2+]) – ([CL-] + [Lactate]) ) is reduced.

Other References

  1. Moviat M, Pickkers P, van der Voort PH, van der Hoeven JG. Acetazolamide-mediated decrease in strong ion difference accounts for the correction of metabolic alkalosis in critically ill patients. Critical Care. 2006;10(1):R14. doi:10.1186/cc3970. Link