Acetazolamide therapy for hypochloremic metabolic alkalosis in pediatric patients with heart disease

Pediatric patients with heart disease are often treated with high doses of diuretics, which can lead to hypochloremic metabolic alkalosis. There are no data in children regarding the efficacy and safety of acetazolamide to treat hypochloremic metabolic alkalosis.

Patients from January 2004 to June 2005 who received acetazolamide were identified. Inclusion criteria were: age less than 18 years, being a cardiology patient, diuretics use, and had received a 3-day course of acetazolamide. Demographic information was collected along with serum electrolytes, serum creatinine/blood urea nitrogen, urine output, pH, acid-base excess, concurrent medications, cardiac lesion/surgery, and incidence of adverse effects. Efficacy of acetazolamide was determined by comparing variables before and after the 3-day course. Statistical comparisons were made using Student's t-test.

A total of 28 patients were identified, 7 of whom received oral acetazolamide, 21 intravenous acetazolamide. Patients were a median of 2.5 (range, 0.3-20) months of age, and 57% (17/28) were female. Seventy-one percent of the cohort received acetazolamide after cardiac surgery. There was no significant difference in any electrolyte, blood urea nitrogen, or serum creatinine from baseline, except for serum bicarbonate, which decreased (36.2 +/- 4.6 vs. 30.9 +/- 4.5 mmol/L, P < 0.001), and chloride, which increased (91.1 +/- 6.8 vs. 95.4 +/- 6.2, P < 0.03). Acid-base excess values and pH decreased during therapy in patients who had the laboratory values drawn (n = 22). No change in urine output at 8 hours (5.2 +/- 2.3 vs. 4.9 +/- 2.3 mL/kg/hr, P = 0.6) or 24 hours (4.7 +/- 1.5 vs. 4.3 +/- 1.4 mL/kg/hr, P = 0.18) occurred after administration of acetazolamide.

Acetazolamide was safely used in pediatric patients with heart disease to lower serum bicarbonate and acid-base excess values and raise chloride values in hypochloremic metabolic alkalosis.