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The effect of oral acetazolamide on weight gain in children
Sapna Sharan1, Annie Dupuis, Diane Hébert
1Ivey Eye Institute, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Insights
Oral acetazolamide is a treatment for pediatric glaucoma. This study found it does not significantly impact weight gain in most children, though some may experience issues, potentially due to metabolic acidosis.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Pharmacology
Background:
- Oral acetazolamide is a key treatment for pediatric glaucoma.
- Concerns exist regarding its potential to impede weight gain in children.
- These concerns may lead to a preference for surgical interventions.
Purpose of the Study:
- To evaluate the effect of oral acetazolamide on weight gain in children with glaucoma.
- To identify potential factors, such as metabolic acidosis, associated with weight changes.
Main Methods:
- Retrospective chart review of 22 children with glaucoma treated with oral acetazolamide for at least 3 months.
- Abnormal weight gain assessed by percentile crossing and change in weight z-score.
- Hierarchical linear modeling used to analyze weight changes.
Main Results:
- Most children (20/22) maintained steady growth. 50% showed a decline in weight z-score, but overall change was not significant (p=0.8).
- Two patients experienced abnormal weight gain, linked to metabolic acidosis, which reversed upon medication cessation.
- One patient with Sturge-Weber syndrome and growth failure was excluded due to diagnosed growth hormone deficiency.
Conclusions:
- Oral acetazolamide is generally not associated with significant weight changes in pediatric glaucoma patients.
- Metabolic acidosis may be a factor in poor weight gain for a small subset of children.
- Continued monitoring of growth parameters is recommended; consider growth hormone deficiency in specific cases like Sturge-Weber syndrome.
Objective:
Oral acetazolamide is a potent medical treatment for pediatric glaucoma, but ophthalmologists may have concerns that it retards weight gain in children and may choose surgical management instead.
Design:
Retrospective chart review.
Participants:
Twenty-two well children with glaucoma taking acetazolamide orally for >or=3 months.
Methods:
Abnormal weight gain was determined using downward crossing of 2 percentile lines on growth charts and change in z score for weight using a hierarchical linear model.
Results:
One patient with Sturge-Weber syndrome and growth failure was excluded when growth hormone deficiency was diagnosed. Two patients crossed 2 lines downward; both showed metabolic acidosis. The trend for the 2 reversed after medication was discontinued. The other 20 tracked steadily on growth curves. Eleven patients (11/22, 50%) showed a decline in z score for weight over the follow-up period, and the remainder showed an increase, for an overall estimate of slope in this sample of 0.01, which was not significant (p = 0.8).
Conclusions:
Oral acetazolamide may cause poor weight gain in a small subset of children on treatment. Metabolic acidosis may be a mediating factor for growth failure. Our data suggest that acetazolamide does not cause significant weight changes in cases of pediatric glaucoma. Growth parameters should be followed. Growth hormone deficiency should be considered in Sturge-Weber syndrome. Prospective study is needed.
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